Provider Demographics
NPI:1902154354
Name:PHILLIPS, JENNIFER MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 E FM 2410 RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5721
Mailing Address - Country:US
Mailing Address - Phone:254-953-0012
Mailing Address - Fax:254-953-0014
Practice Address - Street 1:480 E FM 2410 RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5721
Practice Address - Country:US
Practice Address - Phone:254-953-0012
Practice Address - Fax:254-953-0014
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist