Individual
DR. KELLY JO PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1316 MCMILLAN ST, WORTHINGTON, MN 56187-1646
(507) 376-5525
(507) 376-3796
Mailing address
1316 MCMILLAN ST., PO BOX 727, WORTHINGTON, MN 56187
(507) 376-5525
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12193
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687623400
—
MN
Enumeration date
12/08/2006
Last updated
10/15/2012
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