Individual
BRENDA PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
88 MDG/SGHJ, 4881 SUGAR MAPLE DR., WPAFB, OH 45423
(937) 257-8761
Mailing address
88 MDG/SGHJ, 4881 SUGAR MAPLE DR., WPAFB, OH 45433
(937) 257-8761
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
01-9980
OH
1223G0001X
General Practice Dentistry
30.019980
OH
Other
Enumeration date
06/22/2015
Last updated
10/21/2022
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