Provider Demographics
NPI:1982029849
Name:PHILLIPS, NANCY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
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 1:428 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1524
Mailing Address - Country:US
Mailing Address - Phone:850-224-1213
Mailing Address - Fax:850-222-7215
Practice Address - Street 1:428 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1524
Practice Address - Country:US
Practice Address - Phone:850-224-1213
Practice Address - Fax:850-222-7215
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN115461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice