Provider Demographics
NPI:1205409554
Name:PHILLIPS, CHRISTOPHER KIRK-RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KIRK-RYAN
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 1:1576 BIRCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6871
Mailing Address - Country:US
Mailing Address - Phone:909-856-2011
Mailing Address - Fax:
Practice Address - Street 1:801 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1048
Practice Address - Country:US
Practice Address - Phone:615-563-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106591122300000X
TN11793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist