Provider Demographics
NPI:1639393523
Name:GRANT E PHIPPS DDS PA
Entity Type:Organization
Organization Name:GRANT E PHIPPS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-326-7983
Mailing Address - Street 1:119 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-3046
Mailing Address - Country:US
Mailing Address - Phone:620-326-7983
Mailing Address - Fax:620-326-8094
Practice Address - Street 1:119 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-3046
Practice Address - Country:US
Practice Address - Phone:620-326-7983
Practice Address - Fax:620-326-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty