Provider Demographics
NPI:1376276915
Name:PHILLIPS, BETHANY DEBORAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:DEBORAH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N COOK ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5879
Mailing Address - Country:US
Mailing Address - Phone:509-326-4343
Mailing Address - Fax:509-482-5064
Practice Address - Street 1:4001 N COOK ST FL 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5879
Practice Address - Country:US
Practice Address - Phone:509-326-4343
Practice Address - Fax:509-482-5064
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM25041223G0001X
WADE61434173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice