Provider Demographics
NPI:1396777140
Name:EASTEP, PHILLIP BEN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BEN
Last Name:EASTEP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHERRYVALE
Mailing Address - State:KS
Mailing Address - Zip Code:67335
Mailing Address - Country:US
Mailing Address - Phone:620-336-3766
Mailing Address - Fax:620-336-2502
Practice Address - Street 1:220 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHERRYVALE
Practice Address - State:KS
Practice Address - Zip Code:67335
Practice Address - Country:US
Practice Address - Phone:620-336-3766
Practice Address - Fax:620-336-2502
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice