Provider Demographics
NPI:1760778542
Name:FAUCETTE, PHILLIP HUTSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HUTSON
Last Name:FAUCETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 HILLSBORO PIKE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2782
Mailing Address - Country:US
Mailing Address - Phone:615-383-4455
Mailing Address - Fax:615-383-4032
Practice Address - Street 1:4027 HILLSBORO PIKE
Practice Address - Street 2:SUITE 805
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2782
Practice Address - Country:US
Practice Address - Phone:615-383-4455
Practice Address - Fax:615-383-4032
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93101223G0001X, 1223E0200X
AL5956 C1390200000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist