Provider Demographics
NPI:1285757278
Name:PHIPPS, JOCELYN A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:A
Last Name:PHIPPS
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 1:6287 TAYLORSVILLE RD BLDG 2 STE A
Mailing Address - Street 2:ELK CREEK OFFICE PARK
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-6443
Mailing Address - Country:US
Mailing Address - Phone:502-477-6380
Mailing Address - Fax:502-477-6381
Practice Address - Street 1:6287 TAYLORSVILLE RD BLDG 2 STE A
Practice Address - Street 2:ELK CREEK OFFICE PARK
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-6443
Practice Address - Country:US
Practice Address - Phone:502-477-6380
Practice Address - Fax:502-477-6381
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist