Provider Demographics
NPI:1508035502
Name:DR. KAREN MARTIN-PHILLIPS, DMD,PC
Entity Type:Organization
Organization Name:DR. KAREN MARTIN-PHILLIPS, DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:MARTIN-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-584-1700
Mailing Address - Street 1:478 TORREY ST
Mailing Address - Street 2:UNIT 9
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4696
Mailing Address - Country:US
Mailing Address - Phone:508-584-1700
Mailing Address - Fax:508-427-6068
Practice Address - Street 1:478 TORREY ST
Practice Address - Street 2:UNIT 9
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4696
Practice Address - Country:US
Practice Address - Phone:508-584-1700
Practice Address - Fax:508-427-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty