Keith Alexander Phillips, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

028846 Issued in NY

Practice address

10753 Guy R Brewer Blvd
Jamaica, NY 11433-2351

Phone

(718) 291-9117

Fax

(718) 291-9117

NPI assigned

Sep 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Keith Alexander Phillips Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189382400000",
    "number": "1457546749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130143",
            "city": "LAURELTON",
            "state": "NY",
            "postal_code": "114130143",
            "telephone_number": "718-291-9117",
            "fax_number": "718-291-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10753 GUY R BREWER BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332351",
            "telephone_number": "718-291-9117",
            "fax_number": "718-291-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KEITH",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "028846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00290359",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEITH",
            "last_name": "PHILLIPS",
            "middle_name": "ALEXANDER",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Pharmex Pharmacy Inc.
• Rejomon Philip, PT
• Annabelle Philippe
• Thomas Fredel Philippe
• Guerda Phillips
• Tracy Lee Phillips, D.D.S.
• Phoenix Holistic Services LLC
• Phoenix Home Care Sercives, LLC
• Phoenix Rises Medical Services, P.C.
• Physician Medical Services, PC

• General Practice Dentistry in Jamaica, NY
• Providers in Jamaica, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; 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.