Provider Demographics
NPI:1982869996
Name:PHILLIPS, KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
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 1:10 GALLETA CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2404
Mailing Address - Country:US
Mailing Address - Phone:734-255-6111
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3257
Practice Address - Country:US
Practice Address - Phone:281-296-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190277641223G0001X
TX332131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508198474OtherPRACTICE LOCATION TYPE II NPI
IL1063649770OtherGROUP NPI
1295165439OtherPRACTICE LOCATION TYPE II NPI
1760882005OtherPRACTICE LOCATION TYPE II NPI
IL1053431981OtherGROUP NPI
IL1205145554OtherPRACTICE LOCATION TYPE II NPI
IL1306177241OtherPRACTICE LOCATION TYPE II NPI
1295165439OtherPRACTICE LOCATION TYPE II NPI
IL1053431981OtherGROUP NPI