Provider Demographics
NPI:1407880875
Name:PHILLIPPI, PAUL JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
Last Name:PHILLIPPI
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 1:2770 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4096
Mailing Address - Country:US
Mailing Address - Phone:704-509-4513
Mailing Address - Fax:
Practice Address - Street 1:2770 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4096
Practice Address - Country:US
Practice Address - Phone:704-509-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice