Individual
MEGAN PHILLABAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1401 MADISON AVE, COVINGTON, KY 41011-3313
(859) 655-6100
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10779
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10779
KY LICENSE
KY
Enumeration date
06/08/2022
Last updated
07/26/2022
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