Provider Demographics
NPI:1467715581
Name:PHILLIPS, BRANDON LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:PHILLIPS
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 1:136 ASHLEY OAKS
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3652
Mailing Address - Country:US
Mailing Address - Phone:304-237-8241
Mailing Address - Fax:
Practice Address - Street 1:1150 HEALTH SCIENCES CENTER
Practice Address - Street 2:ROBERT C. BYRD HEALTH SCIENCES CENTER
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9100
Practice Address - Country:US
Practice Address - Phone:304-293-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist