Individual
ALEXIS PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
136 E MALLARD DR, BOISE, ID 83706-3975
(208) 500-5437
(208) 908-6178
Mailing address
130 NATIONAL DR, JOHNS CREEK, GA 30097-2079
(770) 856-1308
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-5002-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346771904
PPO
ID
05
—
1346771904
—
ID
Enumeration date
03/24/2017
Last updated
03/19/2025
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