Provider Demographics
NPI:1114188729
Name:MCPHILLIPS, ANDREA MICHELLE (DDS; MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:MCPHILLIPS
Suffix:
Gender:F
Credentials:DDS; MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 VANTAGE DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1850
Mailing Address - Country:US
Mailing Address - Phone:254-965-2541
Mailing Address - Fax:254-965-4531
Practice Address - Street 1:605 VANTAGE DR
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1850
Practice Address - Country:US
Practice Address - Phone:254-965-2541
Practice Address - Fax:254-965-4531
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22386122300000X
TXD22386204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist