Brenda Phillips

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

01-9980 Issued in OH

Practice address

88 MDG/SGHJ
4881 Sugar Maple Dr.
Wpafb, OH 45423

Phone

(937) 257-8761

NPI assigned

Jun 22, 2015

Last updated

Oct 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Upper Valley Dental Center

  • Dental Clinic/Center
  • Huber Heights, OH
  • NPI 1093195117
  NPD (past) Authorized official

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1760864110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 MDG/SGHJ",
            "address_2": "4881 SUGAR MAPLE DR.",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-257-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 MDG/SGHJ",
            "address_2": "4881 SUGAR MAPLE DR.",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "45423",
            "telephone_number": "937-257-8761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "BRENDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.019980",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "01-9980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Elliot Patel, R. PH.
• Sneh L Patwa, M.D.
• Rachelle Paul-Kagiri, M.D.
• Jamie Penny
• Susan M Perry, CRNA
• Tyler L Pierce, MD
• Jessica Porcelan, MD
• Susan Porter, M.D.
• Michelle L Price, PHARMD
• Paul Puchta, M.D.

• General Practice Dentistry in Wpafb, OH
• Providers in Wpafb, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.