Provider Demographics
NPI:1346324621
Name:PHILLIPS, AARON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:L
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 1:702 BARON DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1013
Mailing Address - Country:US
Mailing Address - Phone:618-277-5988
Mailing Address - Fax:618-277-3088
Practice Address - Street 1:901 E CHAPIN ST
Practice Address - Street 2:M&M DENTAL CLINIC
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1350
Practice Address - Country:US
Practice Address - Phone:217-342-3761
Practice Address - Fax:217-324-0313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003323Medicaid