Provider Demographics
NPI:1508046327
Name:ALIX PHILLIPS, DMD, INC.
Entity Type:Organization
Organization Name:ALIX PHILLIPS, DMD, INC.
Other - Org Name:DENTAL ARTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ALIX
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-393-7500
Mailing Address - Street 1:90 W CALLE DE LAS TIENDAS
Mailing Address - Street 2:STE. 150
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4295
Mailing Address - Country:US
Mailing Address - Phone:520-393-7500
Mailing Address - Fax:520-399-0147
Practice Address - Street 1:90 W CALLE DE LAS TIENDAS
Practice Address - Street 2:STE. 150
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4295
Practice Address - Country:US
Practice Address - Phone:520-393-7500
Practice Address - Fax:520-399-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty