Provider Demographics
NPI:1043363526
Name:PHILLIPS, CHRISTOPHER B (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:M
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:HEATH SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29058-0455
Mailing Address - Country:US
Mailing Address - Phone:803-273-9336
Mailing Address - Fax:803-273-3202
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEATH SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29058
Practice Address - Country:US
Practice Address - Phone:803-273-9336
Practice Address - Fax:803-273-3202
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice