Provider Demographics
NPI:1043431323
Name:EASTER, PHILLIP BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BRUCE
Last Name:EASTER
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 1:3935 EAGLE CREEK PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4690
Mailing Address - Country:US
Mailing Address - Phone:317-291-1000
Mailing Address - Fax:317-291-3400
Practice Address - Street 1:3935 EAGLE CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4690
Practice Address - Country:US
Practice Address - Phone:317-291-1000
Practice Address - Fax:317-291-3400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009229A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist