Provider Demographics
NPI:1588864045
Name:PHELPS, JOY (DMD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 WHITESIDE RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2345
Mailing Address - Country:US
Mailing Address - Phone:804-322-3669
Mailing Address - Fax:804-326-1467
Practice Address - Street 1:5506 WHITESIDE RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2345
Practice Address - Country:US
Practice Address - Phone:804-322-3669
Practice Address - Fax:804-326-1467
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4014115121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry