Provider Demographics
NPI:1659602498
Name:PHELPS & PHELPS, DDS, PA
Entity Type:Organization
Organization Name:PHELPS & PHELPS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-762-3481
Mailing Address - Street 1:2471 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6061
Mailing Address - Country:US
Mailing Address - Phone:910-762-3481
Mailing Address - Fax:910-762-0819
Practice Address - Street 1:2471 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6061
Practice Address - Country:US
Practice Address - Phone:910-762-3481
Practice Address - Fax:910-762-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60771223G0001X
NC60781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty