Provider Demographics
NPI:1558431262
Name:PHILLIPS, ROBERT A (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:11740 OLIO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7614
Mailing Address - Country:US
Mailing Address - Phone:317-570-9500
Mailing Address - Fax:317-570-9555
Practice Address - Street 1:11740 OLIO ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:317-570-9500
Practice Address - Fax:317-570-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009284 A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice