Daniella Anne Phillis, D.M.D.
Individual provider Active NPI Dentist · Durango, CO
NPI 1588090831 · NPPES record last updated Nov 18, 2016
Key facts
- NPI
- 1588090831
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 00202801 (CO)
- Practice address
- 3057 Main Ave
Durango, CO 81301-4244 - Phone
- (970) 247-5874
- NPI assigned
- Sep 18, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00202801 | CO | MD | Dentist |
| 1856312 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Smile by Design | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1856312 | MA | |
| Dentist | 122300000X | 00202801 | CO | Yes |
Addresses
Primary practice location
3057 Main Ave
Durango, CO 81301-4244
Mailing address
24B Coalbank Dr
Durango, CO 81301-9477
Other providers in Durango, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.