Provider Demographics
NPI:1952977977
Name:PHILLIPPI, LAURIE KENDALL (DMD)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:KENDALL
Last Name:PHILLIPPI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 WAYNETOWNE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2124
Mailing Address - Country:US
Mailing Address - Phone:937-237-0360
Mailing Address - Fax:
Practice Address - Street 1:5221 WAYNETOWNE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-2124
Practice Address - Country:US
Practice Address - Phone:937-237-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist