Eric Phan, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

11086 Issued in TN

Practice address

614 E Clark Blvd
Murfreesboro, TN 37130-2121

Phone

(615) 890-0885

NPI assigned

Jan 15, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McKee, Curry, Stanley, Pediatric Dentistry Partnership

  • Pediatric Dentistry
  • Murfreesboro, TN
  • NPI 1942281571
  NPD (past)

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1477061273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E CLARK BLVD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302121",
            "telephone_number": "615-890-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 E CLARK BLVD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302121",
            "telephone_number": "615-890-0885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 E Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Tullahoma",
            "state": "TN",
            "postal_code": "373883750",
            "country_code": "US",
            "telephone_number": "931-841-3113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-15",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "11086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Petrilli
• Michael Paul Petroka, M.A.
• Jill K Petry, PTA
• Marissa R Pettis
• Morgan Petty
• Nikki Phanyoraj, FNP-C
• Pharmacist on Call LLC
• Pharmalife Community Pharmacy, LLC
• Pharmalife Community Pharmacy, LLC
• Siriporn Philavanh

• Pediatric Dentistry in Murfreesboro, TN
• Providers in Murfreesboro, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.