Provider Demographics
NPI:1568702074
Name:TRAVIS P. PHILLIPS, DMD, LLC
Entity Type:Organization
Organization Name:TRAVIS P. PHILLIPS, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-831-1333
Mailing Address - Street 1:1695 GOLDEN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-7097
Mailing Address - Country:US
Mailing Address - Phone:256-831-1333
Mailing Address - Fax:256-831-1837
Practice Address - Street 1:1695 GOLDEN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-7097
Practice Address - Country:US
Practice Address - Phone:256-831-1333
Practice Address - Fax:256-831-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51520429OtherBCBS