DC Southern Dental PPO PC

Primary specialty

DenturistTaxonomy code 122400000X

Legal business name

DC SOUTHERN DENTAL PPO PC

Doing business as

Phillips, Cooper & Associates

Practice address

1625 K St NW # LL
Washington, DC 20006-1604

Phone

(202) 463-2090

NPI assigned

Jan 30, 2025

Organization subpart

Yes

Parent organization

DC SOUTHERN DENTAL PPO PCAs reported in NPPES

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

Authorized official

Name

Erika Menjivar

Title

Sr. Credentialing Specialist

Phone

(469) 596-6137

Specialties & licenses 1

Addresses

Other names 1

• Phillips, Cooper & Associates Doing business as

Tax ID family

DC Southern Dental PPO PC2 organizations share this tax ID, including this one

Part of

DC Southern Dental PPO PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• DC Southern Dental PPO PC

  • Dentist
  • Washington, DC
  • NPI 1942013222
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronald L Cooper, DDS

  • General Practice Dentistry
  • Washington, DC
  • NPI 1699980201
  NPD (past)
• Russell Wilbur Phillips, DMD

  • General Practice Dentistry
  • Washington, DC
  • NPI 1629282660
  NPD (past)

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1457164758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 GRANITE PKWY STE 780M",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 K ST NW # LL",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200061604",
            "telephone_number": "202-463-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DC SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DC SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "MENJIVAR",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_title_or_position": "SR. CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "469-596-6137"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Denturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phillips, Cooper & Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Denturist in Washington, DC
• Providers in Washington, DC by specialty
• Denturist in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.