Provider Demographics
NPI:1306285762
Name:PHILLIPS, ROBERT JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 W LAKE ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4252
Mailing Address - Country:US
Mailing Address - Phone:952-926-0284
Mailing Address - Fax:
Practice Address - Street 1:3922 W 50TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1255
Practice Address - Country:US
Practice Address - Phone:952-926-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist