Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22386 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | D22386 | TX |
NPI | 1114188729 |
---|---|
Provider Name | Andrea Michelle Mcphillips |
First Address | Stephenville, TX 76401-1850 |
Second Address | Stephenville, TX 76401-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 03/03/2016 |