Matthew Benjamin Phillips, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DEN.00009022 Issued in CO

Practice address

BLDG 38717 38TH Street
Fort Gordon, GA 30905

Phone

(706) 787-6927

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1417907338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 38717 38TH STREET",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "30905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 38717 38TH STREET",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-6927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "MATTHEW",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00009022",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054351",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "DEN.00009022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Scott Perkins, RN
• Michael E Perry, PH.D.
• Keith David Pfeifer, D.P.M.
• Brian Jacob Pfeiffer, PH.D.
• Fabiola Philippe, DNP
• Sheldon John Phillips
• Jacqueline D Plummer, BSN, RN
• Tamara Polidore-Leconte, OTR
• Elizabeth Lee Pollock, LCSW-C
• Kelly Denise Poole

• Endodontics in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Endodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.

Verify at the official NPI Registry.