Provider Demographics
NPI:1891042982
Name:PHILLIPS, RITA ATWELL (RDH)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:ATWELL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COVE HILLS LN
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4460
Mailing Address - Country:US
Mailing Address - Phone:276-620-1415
Mailing Address - Fax:276-223-4859
Practice Address - Street 1:35 COVE HILLS LN
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4460
Practice Address - Country:US
Practice Address - Phone:276-620-1415
Practice Address - Fax:276-223-4859
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402003103124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist