John C. Phillips III, DDS
Individual provider Active NPI General Practice Dentistry · Chickasha, OK
NPI 1407890635 · NPPES record last updated Nov 29, 2007
Key facts
- NPI
- 1407890635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- BP5225277 (OK)
- Practice address
- 2900 W. Grand Ave.
Chickasha, OK 73018 - Phone
- (405) 222-0222
- Fax
- (405) 222-0210
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 25, 2016 through Apr 25, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP5225277 | OK | MD | General Practice Dentistry |
| 5289 | OK | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elgin Dental Care PC | Current | Accepting new patients | |
| 29TH Street Dental Care | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | BP5225277 | OK | Yes |
Addresses
Primary practice location
2900 W. Grand Ave.
Chickasha, OK 73018
Mailing address
2900 W. Grand Ave.
Chickasha, OK 73018
Phone (405) 222-0222
Other providers in Chickasha, OK
- Patriot Health Transport, LLC
- Amanda Lynn Paul
- Pediatric Pathways LLC
- Emily Brooke Perkins
- Ladonna Phariss
- Cyndra Ann Pilkington
- Pioneer Public Schools
- Lindsey Renea Poindexter
- John Edward Presley
- Cambrie Price
All providers in Chickasha, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.