Provider Demographics
NPI:1861715864
Name:DR GREG PHILLIPS
Entity type:Organization
Organization Name:DR GREG PHILLIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-869-4422
Mailing Address - Street 1:1960 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5119
Mailing Address - Country:US
Mailing Address - Phone:225-869-4422
Mailing Address - Fax:225-869-8306
Practice Address - Street 1:1960 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5119
Practice Address - Country:US
Practice Address - Phone:225-869-4422
Practice Address - Fax:225-869-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty