Provider Demographics
NPI:1891876108
Name:PHILLIPS, MICHELLE V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:V
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EAGLET CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6974
Mailing Address - Country:US
Mailing Address - Phone:925-426-8884
Mailing Address - Fax:925-426-0650
Practice Address - Street 1:3 EAGLET CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6974
Practice Address - Country:US
Practice Address - Phone:925-426-8884
Practice Address - Fax:925-426-0650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice