Provider Demographics
NPI:1124438668
Name:COMBEST, PHYLICIA (DDS)
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
Last Name:COMBEST
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 1:3852 TELEPHONE RD APT 3204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-5754
Mailing Address - Country:US
Mailing Address - Phone:228-249-2184
Mailing Address - Fax:
Practice Address - Street 1:900 S WAYSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3418
Practice Address - Country:US
Practice Address - Phone:832-203-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001361122300000X
TX316381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist