Provider Demographics
NPI:1033209275
Name:PHILLIPS, GERALYN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALYN
Middle Name:N
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6297 W FUQUA ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2828
Mailing Address - Country:US
Mailing Address - Phone:281-437-7437
Mailing Address - Fax:281-437-7438
Practice Address - Street 1:6297 W FUQUA ST
Practice Address - Street 2:SUITE F
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2828
Practice Address - Country:US
Practice Address - Phone:281-437-7437
Practice Address - Fax:281-437-7438
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice