Provider Demographics
NPI:1629858154
Name:PHIPPS, ALEXIS (RDH)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 SEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3190
Mailing Address - Country:US
Mailing Address - Phone:509-492-6284
Mailing Address - Fax:
Practice Address - Street 1:5105 SEVILLE DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3190
Practice Address - Country:US
Practice Address - Phone:509-492-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61087773124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist