Provider Demographics
NPI:1649666355
Name:SCOTT B PHILLIPPI DDS LLC
Entity type:Organization
Organization Name:SCOTT B PHILLIPPI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:PHILLIPPI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-554-0861
Mailing Address - Street 1:5221 WAYNETOWNE CT
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2124
Mailing Address - Country:US
Mailing Address - Phone:937-237-0360
Mailing Address - Fax:937-237-2707
Practice Address - Street 1:5221 WAYNETOWNE CT
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2124
Practice Address - Country:US
Practice Address - Phone:937-237-0360
Practice Address - Fax:937-237-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022577261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1649479643OtherINDIVIDUAL NPI