Provider Demographics
NPI:1659406395
Name:KENT L. PHILLIPS, D.D.S., M.S., LTB.
Entity Type:Organization
Organization Name:KENT L. PHILLIPS, D.D.S., M.S., LTB.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:775-332-1750
Mailing Address - Street 1:390 N STEPHANIE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8028
Mailing Address - Country:US
Mailing Address - Phone:702-565-4646
Mailing Address - Fax:702-565-7069
Practice Address - Street 1:390 N STEPHANIE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8028
Practice Address - Country:US
Practice Address - Phone:702-565-4646
Practice Address - Fax:702-565-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty