Individual
DR. KENNETH R PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3165 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-3919
(336) 760-9840
(336) 760-9841
Mailing address
3165 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-3919
(336) 760-9840
(336) 760-9841
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2292
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
466090
UNITED CONCORDIA
NC
05
—
8996865
—
NC
01
—
96865
BCBS
NC
Enumeration date
08/01/2006
Last updated
07/08/2007
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