Provider Demographics
NPI:1043452758
Name:PHILLIPS, BARBARA LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNN
Last Name:PHILLIPS
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:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-0890
Mailing Address - Country:US
Mailing Address - Phone:715-358-0502
Mailing Address - Fax:715-358-0504
Practice Address - Street 1:8815 COUNTY RD J
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9636
Practice Address - Country:US
Practice Address - Phone:715-358-0502
Practice Address - Fax:715-358-0504
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6748-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry