Provider Demographics
NPI:1417344078
Name:PAUL JEFFREY PHILLIPS D.D.S.
Entity Type:Organization
Organization Name:PAUL JEFFREY PHILLIPS D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-483-7851
Mailing Address - Street 1:400 LABORATORY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6810
Mailing Address - Country:US
Mailing Address - Phone:865-483-7851
Mailing Address - Fax:865-483-6391
Practice Address - Street 1:400 LABORATORY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6810
Practice Address - Country:US
Practice Address - Phone:865-483-7851
Practice Address - Fax:865-483-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS43501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty