Provider Demographics
NPI:1831384056
Name:PHILLIPS, ELIZABETH T (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:PHILLIPS
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:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-5000
Mailing Address - Country:US
Mailing Address - Phone:989-584-3941
Mailing Address - Fax:989-584-6579
Practice Address - Street 1:10274 E BOYER RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9746
Practice Address - Country:US
Practice Address - Phone:989-584-3941
Practice Address - Fax:989-584-6579
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist