Provider Demographics
NPI:1467430868
Name:PHIPPS, GRANT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:E
Last Name:PHIPPS
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 1:1223 N ROCK RD
Mailing Address - Street 2:J-200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1269
Mailing Address - Country:US
Mailing Address - Phone:316-634-1911
Mailing Address - Fax:
Practice Address - Street 1:1223 N ROCK RD
Practice Address - Street 2:J-200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1269
Practice Address - Country:US
Practice Address - Phone:316-634-1911
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice