Provider Demographics
NPI:1023204419
Name:PHILLIPS, BIVIN (DDS)
Entity Type:Individual
Prefix:
First Name:BIVIN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AGORA DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6859
Mailing Address - Country:US
Mailing Address - Phone:410-879-4363
Mailing Address - Fax:
Practice Address - Street 1:1201 AGORA DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-6859
Practice Address - Country:US
Practice Address - Phone:410-879-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist