Provider Demographics
NPI:1700816618
Name:PHILLIPS, VIRGINIA ALIX (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ALIX
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W CALLE DE LAS TIENDAS
Mailing Address - Street 2:STE. 100
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4295
Mailing Address - Country:US
Mailing Address - Phone:520-393-7500
Mailing Address - Fax:520-399-0147
Practice Address - Street 1:90 W CALLE DE LAS TIENDAS
Practice Address - Street 2:STE. 100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4295
Practice Address - Country:US
Practice Address - Phone:520-393-7500
Practice Address - Fax:520-399-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice