Provider Demographics
NPI:1306469382
Name:PHIPPS FAMILY DENTISTRY
Entity type:Organization
Organization Name:PHIPPS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-224-6616
Mailing Address - Street 1:807 W CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9705
Mailing Address - Country:US
Mailing Address - Phone:479-244-6616
Mailing Address - Fax:479-224-6749
Practice Address - Street 1:807 W CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9705
Practice Address - Country:US
Practice Address - Phone:479-244-6616
Practice Address - Fax:479-224-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216685608Medicaid