Provider Demographics
NPI:1760910590
Name:PHILLIPS, JOSHUA RODRIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RODRIC
Last Name:PHILLIPS
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 1:3716 JIM ROBISON DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6319
Mailing Address - Country:US
Mailing Address - Phone:405-503-3488
Mailing Address - Fax:
Practice Address - Street 1:6217 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1605
Practice Address - Country:US
Practice Address - Phone:405-896-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist