Provider Demographics
NPI:1619573201
Name:RACHELLE I. PHILLIPS DMD, P.C.
Entity Type:Organization
Organization Name:RACHELLE I. PHILLIPS DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:I
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-954-8029
Mailing Address - Street 1:20 GINGER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3403
Mailing Address - Country:US
Mailing Address - Phone:618-954-8029
Mailing Address - Fax:
Practice Address - Street 1:2006 MALL ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1831
Practice Address - Country:US
Practice Address - Phone:618-345-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental