Provider Demographics
NPI:1467572206
Name:PHILLEY, JAMES R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:PHILLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5400
Mailing Address - Country:US
Mailing Address - Phone:662-226-6014
Mailing Address - Fax:662-226-9986
Practice Address - Street 1:2117 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5400
Practice Address - Country:US
Practice Address - Phone:662-226-6014
Practice Address - Fax:662-226-9986
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1896-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice