Provider Demographics
NPI:1699003566
Name:R.M.PHILLIPS, D.M.D. AND J.R.LAUGHLIN,D.M.D., INC.
Entity Type:Organization
Organization Name:R.M.PHILLIPS, D.M.D. AND J.R.LAUGHLIN,D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-838-4200
Mailing Address - Street 1:3302 MCFADDIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5038
Mailing Address - Country:US
Mailing Address - Phone:409-838-4200
Mailing Address - Fax:409-838-0109
Practice Address - Street 1:3302 MCFADDIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5038
Practice Address - Country:US
Practice Address - Phone:409-838-4200
Practice Address - Fax:409-838-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73241223S0112X
TX105241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty