Active NPI
Cristen Nicole Phillips, DMD
- Dentist
- Virginia Beach, VA
National Provider Identifier
1396420360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401419006
- Practice address
- 904 Kempsville Rd Ste 103
Virginia Beach, VA 23464-5571 - Phone
- (757) 467-6453
- NPI assigned
- Jun 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401419006 | VA | Primary |
Addresses
Primary practice location
904 Kempsville Rd Ste 103
Virginia Beach, VA 23464-5571
Mailing address
201 Oak St
West Hempstead, NY 11552-2135
Phone (516) 967-9067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231024003746 | AZ | Order and Referring Only - Dentist | 4385090596 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786406400000",
"number": "1396420360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 OAK ST",
"city": "WEST HEMPSTEAD",
"state": "NY",
"postal_code": "115522135",
"telephone_number": "516-967-9067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 KEMPSVILLE RD STE 103",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234645571",
"telephone_number": "757-467-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "CRISTEN",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-19",
"last_updated": "2026-08-11",
"certification_date": "2026-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401419006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.