Mark E Phillips, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13139 Issued in OH

Practice address

201 Van Gundy Dr Ste a
Bryan, OH 43506-1179

Phone

(419) 636-4202

Fax

(419) 636-6976

NPI assigned

Feb 12, 2008

Sex

Male

Sole proprietor

No

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

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.

Opted out of Medicare

Yes, effective Jun 29, 2015 through Jun 29, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Daniel Whittaker R DMD, Inc.

  • Dentist
  • Bryan, OH
  • NPI 1629484118
  NPD (past)
• DRS. Hanna and Phillips D.D.S. and Associates, Inc.

  • General Practice Dentistry
  • Bryan, OH
  • NPI 1164557377

  General Practice

  NPD (past)

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1295903391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 VAN GUNDY DR STE A",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061179",
            "telephone_number": "419-636-4202",
            "fax_number": "419-636-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 VAN GUNDY DR STE A",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061179",
            "telephone_number": "419-636-4202",
            "fax_number": "419-636-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-12",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "13139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peters Family Eyecare Associates
• Diane Peters, PSY.D.
• Randy L Peters, O.D.
• Ryan Peters I
• Darisa Phillips, COTA/L
• Larry Michael Pickett, CRNA
• Tiffany Rae Poletta, COTA/L
• Brianna Rae Pool, A-GNP
• Sara Porter
• Nicole Marie Pothast, MSN, CNM

• General Practice Dentistry in Bryan, OH
• Providers in Bryan, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.