Provider Demographics
NPI:1063100691
Name:PHEN, CODY (DMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:PHEN
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 1:100 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-8161
Mailing Address - Country:US
Mailing Address - Phone:252-332-1904
Mailing Address - Fax:
Practice Address - Street 1:904 COLONY AVE N
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2108
Practice Address - Country:US
Practice Address - Phone:919-225-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program