Carol Lynn Phillips, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D-25359 Issued in CA

Practice address

3046 S Higuera St
Suite C
San Luis Obispo, CA 93401-6622

Phone

(805) 541-1004

Fax

(805) 541-2523

NPI assigned

Jul 20, 2007

Last updated

Jul 20, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184889600000",
    "number": "1114127701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3046 S HIGUERA ST",
            "address_2": "SUITE C",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016622",
            "telephone_number": "805-541-1004",
            "fax_number": "805-541-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3046 S HIGUERA ST",
            "address_2": "SUITE C",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016622",
            "telephone_number": "805-541-1004",
            "fax_number": "805-541-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CAROL",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "D-25359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Petrik, D.D.S.
• Pharmarx Pharmaceutical Inc
• Pharmerica Drug Systems LLC (Pharmerica)
• Phillip Kissel MD, a Professional Corporation
• Phillip M. Colbert, MD,, a Medical Corporation
• Kimberly Phillips, NP
• Luke Phillips, PT
• Tina Danielle Phipps
• John R Phirman, M.D.
• Lee J Piatek, M.D.

• Dentist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.