Provider Demographics
NPI:1548462369
Name:PHILLIPS, COOPER AND ASSOCIATES
Entity type:Organization
Organization Name:PHILLIPS, COOPER AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-463-2090
Mailing Address - Street 1:1625 K ST NW
Mailing Address - Street 2:SUITE #1, LOWER LEVEL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1604
Mailing Address - Country:US
Mailing Address - Phone:202-463-2090
Mailing Address - Fax:202-463-7868
Practice Address - Street 1:1625 K ST NW
Practice Address - Street 2:SUITE #1, LOWER LEVEL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1604
Practice Address - Country:US
Practice Address - Phone:202-463-2090
Practice Address - Fax:202-463-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3717122300000X
DC50411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty