Provider Demographics
NPI:1275661183
Name:PHILLIPS, KENT L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8490 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-7550
Mailing Address - Country:US
Mailing Address - Phone:775-851-8490
Mailing Address - Fax:775-332-1753
Practice Address - Street 1:5220 NEIL RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6505
Practice Address - Country:US
Practice Address - Phone:775-332-1750
Practice Address - Fax:775-332-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics