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Individual

HAYDEN R. PHILLIPS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1012 IVAL JAMES BLVD, C, RICHMOND, KY 40475-8174
(859) 626-9620
(859) 626-9622
Mailing address
1012 IVAL JAMES BLVD, C, RICHMOND, KY 40475-8174
(859) 626-9620
(859) 626-9622

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7982
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1500
BLUE CROSS/BLUE SHIELD ID
KY
05
60003282
KY
05
61901088
KY
05
61901211
KY
01
7982
DELTA DENTAL ID#
KY
Enumeration date
09/14/2006
Last updated
04/21/2015
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