Individual provider Active NPI

David M Phillips, DDS

  • General Practice Dentistry
  • Gastonia, NC
National Provider Identifier
1164408449
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5877 Issued in NC
Practice address
991 W Hudson Blvd
Gastonia, NC 28052-6430
Phone
(704) 853-5048
Fax
(704) 671-1404
NPI assigned
Dec 19, 2005
Last updated
Aug 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5877 NC Primary

Addresses

Primary practice location

991 W Hudson Blvd
Gastonia, NC 28052-6430

Mailing address

991 W Hudson Blvd
Gastonia, NC 28052-6430
Phone (704) 853-5048

Other identifiers 1

IdentifierTypeStateIssuer
8996864MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20160401000464 NC Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9739486945

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5877NCMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1164408449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 W HUDSON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280526430",
            "telephone_number": "704-853-5048",
            "fax_number": "704-671-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 W HUDSON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280526430",
            "telephone_number": "704-853-5048",
            "fax_number": "704-671-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "DAVID",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8996864",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.