Provider Demographics
NPI:1619975406
Name:PHILLIPS, JAMES B (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
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 1:2609 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7227
Mailing Address - Country:US
Mailing Address - Phone:870-931-3000
Mailing Address - Fax:
Practice Address - Street 1:2609 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7227
Practice Address - Country:US
Practice Address - Phone:870-931-3000
Practice Address - Fax:870-931-0190
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-04-23
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
AR23411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56350Medicare ID - Type Unspecified
ART20364Medicare UPIN