Provider Demographics
NPI:1013880061
Name:PHILLIPS, CONSTANCE BAKER (DDS)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:BAKER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:LOUISE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:99 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1901
Mailing Address - Country:US
Mailing Address - Phone:917-407-3847
Mailing Address - Fax:
Practice Address - Street 1:11833 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7203
Practice Address - Country:US
Practice Address - Phone:718-779-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038887-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist