Provider Demographics
NPI:1700905080
Name:DICKINSON-BRANCH, PHYLLIS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:A
Last Name:DICKINSON-BRANCH
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 1:2130 W. POPLAR AVE, SUITE 106
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-861-7007
Mailing Address - Fax:901-861-7066
Practice Address - Street 1:2130 W. POPLAR AVE, SUITE 106
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-861-7007
Practice Address - Fax:901-861-7066
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice