Provider Demographics
NPI:1720107576
Name:PHILLIPS, JAMES LEE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:PHILLIPS
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:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-0266
Mailing Address - Country:US
Mailing Address - Phone:740-384-6888
Mailing Address - Fax:
Practice Address - Street 1:22 NORTH OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-0266
Practice Address - Country:US
Practice Address - Phone:740-384-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH171941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0505984Medicaid