Provider Demographics
NPI:1649479643
Name:PHILLIPPI, SCOTT BRADFORD (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:BRADFORD
Last Name:PHILLIPPI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1655
Mailing Address - Country:US
Mailing Address - Phone:937-376-9975
Mailing Address - Fax:937-376-8252
Practice Address - Street 1:1289 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1655
Practice Address - Country:US
Practice Address - Phone:937-376-9975
Practice Address - Fax:937-376-8252
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0225771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice