Provider Demographics
NPI:1588733026
Name:PHILLIPS-SMELTZER, MARILYN LIZ (DDS)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LIZ
Last Name:PHILLIPS-SMELTZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1815 STUART AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4374
Mailing Address - Country:US
Mailing Address - Phone:423-472-4621
Mailing Address - Fax:
Practice Address - Street 1:1815 STUART AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4374
Practice Address - Country:US
Practice Address - Phone:423-472-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621827508OtherTAX ID#