Provider Demographics
NPI:1306916655
Name:PHILLIPS, TIMOTHY BROWN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BROWN
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 1:111 MONUMENT CIRCLE
Mailing Address - Street 2:CHASE TOWER SUITE 3020
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-632-1488
Mailing Address - Fax:317-686-1692
Practice Address - Street 1:111 MONUMENT CIRCLE
Practice Address - Street 2:CHASE TOWER SUITE 3020
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-632-1488
Practice Address - Fax:317-686-1692
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice