Provider Demographics
NPI:1518528769
Name:PHILLIPS, HUEY D JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUEY
Middle Name:D
Last Name:PHILLIPS
Suffix:JR
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 1:3127 E SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2910
Mailing Address - Country:US
Mailing Address - Phone:662-287-3373
Mailing Address - Fax:662-562-9822
Practice Address - Street 1:3127 E SHILOH RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2910
Practice Address - Country:US
Practice Address - Phone:662-287-3373
Practice Address - Fax:662-287-3373
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4078-191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice