Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6772 | NC |
NPI | 1144359480 |
---|---|
Provider Name | Dr. John Lloyd Phillips |
First Address | Fayetteville, NC 28311-2946 |
Second Address | Fayetteville, NC 28303-4913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2007 |
Last Update Date | 08/07/2007 |