Provider Demographics
NPI:1538298443
Name:PHILIPOSE, JOHN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:PHILIPOSE
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 1:102 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4641
Mailing Address - Country:US
Mailing Address - Phone:615-867-6960
Mailing Address - Fax:
Practice Address - Street 1:102 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4872
Practice Address - Country:US
Practice Address - Phone:615-867-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics