David M Phillips, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11114 Issued in MN

Practice address

11237 Foley Blvd NW
Coon Rapids, MN 55448-3389

Phone

(763) 757-3120

Fax

(763) 757-5161

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407369600000",
    "number": "1154311181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 OSCEOLA AVE",
            "address_2": "APT #204",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052348",
            "telephone_number": "651-207-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11237 FOLEY BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554483389",
            "telephone_number": "763-757-3120",
            "fax_number": "763-757-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2014-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11114",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marci Lynn Pettman, PT
• Kendall Petty, CRNA
• Sean Matthew Pfundstein, PHARMD
• Michael Philbrook, PHARM.D.
• Cheyenne Rose Phillips
• Tiffany Phu
• Gretchen Phung, DMFT, LMFT
• Jonathan David Pieper, MA, LMFT
• Celina M Pierce
• Stacy May Piere, MSW, LICSW

• General Practice Dentistry in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; 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.