Provider Demographics
NPI:1245230150
Name:PHILLIPS, JAMES JACKSON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JACKSON
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4027
Mailing Address - Country:US
Mailing Address - Phone:334-821-5291
Mailing Address - Fax:334-821-5292
Practice Address - Street 1:761 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4027
Practice Address - Country:US
Practice Address - Phone:334-821-5291
Practice Address - Fax:334-821-5292
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice