Provider Demographics
NPI:1629397302
Name:SAVAGE, PHILLIP LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LANE
Last Name:SAVAGE
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 1:772 STILL RUN LN
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-9488
Mailing Address - Country:US
Mailing Address - Phone:336-227-1367
Mailing Address - Fax:
Practice Address - Street 1:150 W CRESCENT SQUARE DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-4014
Practice Address - Country:US
Practice Address - Phone:336-570-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice