Justin D. Phillips, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

43845 Issued in CA

Practice address

2655 Cleveland Ave Ste B
Santa Rosa, CA 95403-2779

Phone

(707) 542-1026

Fax

(707) 542-1058

NPI assigned

Oct 5, 2007

Last updated

Oct 5, 2007By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1184812091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 CLEVELAND AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032779",
            "telephone_number": "707-542-1026",
            "fax_number": "707-542-1058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 CLEVELAND AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032779",
            "telephone_number": "707-542-1026",
            "fax_number": "707-542-1058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JUSTIN",
        "middle_name": "D.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Souliyo Phetsomphou
• Philippe Edouard, M.D., Inc.
• Deirdre Phillips
• Dustin Phillips
• Elizabeth Phillips, MD
• Karen Phillips
• Kayli Khamvanh Phommavongsa
• Esamou Phongsa-Chu, FNP
• Jenny Phung
• Physiotherapy Associates Inc

• General Practice Dentistry in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.