Mary Bernadette Philp, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13148 Issued in MN

Practice address

5205 Shoreline Drive
Mound, MN 55364

Phone

(952) 472-7717

Fax

(612) 392-7915

NPI assigned

Jul 25, 2011

Last updated

Oct 3, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Lakes Dentistry, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Mound, MN
  • NPI 1497113674
  NPD (past)

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1538447644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5205 SHORELINE DRIVE",
            "city": "MOUND",
            "state": "MN",
            "postal_code": "55364",
            "telephone_number": "952-472-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 SHORELINE DRIVE",
            "city": "MOUND",
            "state": "MN",
            "postal_code": "55364",
            "telephone_number": "952-472-7717",
            "fax_number": "612-392-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILP",
        "first_name": "MARY",
        "middle_name": "BERNADETTE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "R514",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayme Lynn Moulton, DC
• Mound Back & Neck Clinic Limited
• Msi Health Care Supply
• Melissa Louwagie Patterson, MA, LPCC, LADC
• Christine Chapman Paulson, LMFT
• Caitlyn Pote, RD
• Tracy Elizabeth Pozar, CFNP
• Danielle Ann Pulkrabek, ATR, CSCS
• Ellie Rautio, RD
• Jeanne Lucille Savoie

• Dentist in Mound, MN
• Providers in Mound, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.