Provider Demographics
NPI:1720642150
Name:PHILLIPS ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:PHILLIPS ORTHODONTICS, PLLC
Other - Org Name:PHILLIPS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:432-203-6905
Mailing Address - Street 1:4425 W WADLEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5330
Mailing Address - Country:US
Mailing Address - Phone:432-203-6905
Mailing Address - Fax:
Practice Address - Street 1:4425 W WADLEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5330
Practice Address - Country:US
Practice Address - Phone:432-203-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental