Active NPI
Brock Philips, DMD
- General Practice Dentistry
- Jacksonville, FL
National Provider Identifier
1699094151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN14354
- Practice address
- 4540 Southside Blvd
Suite 801
Jacksonville, FL 32216-5492 - Phone
- (904) 642-2010
- Fax
- (904) 642-8282
- NPI assigned
- May 24, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN14354 | FL | Primary |
Addresses
Primary practice location
4540 Southside Blvd
Suite 801
Jacksonville, FL 32216-5492
Mailing address
4540 Southside Blvd
Suite 801
Jacksonville, FL 32216-5492
Phone (904) 642-2010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14354 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amando Dental Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Preferred Provider Organization
- Jacksonville, FL
- NPI 1275739237
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1699094151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 SOUTHSIDE BLVD",
"address_2": "SUITE 801",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322165492",
"telephone_number": "904-642-2010",
"fax_number": "904-642-8282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 SOUTHSIDE BLVD",
"address_2": "SUITE 801",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322165492",
"telephone_number": "904-642-2010",
"fax_number": "904-642-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILIPS",
"first_name": "BROCK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-24",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN14354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.