Organization
DR PHILLIPS DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KELLY (OWNER)
(410) 303-1528
Entity
Organization
Contact information
Practice address
7800 W SAND LAKE RD STE 220, ORLANDO, FL 32819-5198
(407) 226-3350
Mailing address
7800 W SAND LAKE RD STE 220, ORLANDO, FL 32819-5198
(407) 226-3350
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN11133
STATE LICENSE
FL
01
—
DN19430
STATE LICENSE
FL
01
—
DN25609
STATE LICENSE
FL
Enumeration date
02/08/2021
Last updated
02/08/2021
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