Provider Demographics
NPI:1184352536
Name:PHILLIPS, KAITLYN
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 US HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6377
Mailing Address - Country:US
Mailing Address - Phone:937-393-4343
Mailing Address - Fax:937-900-0641
Practice Address - Street 1:4503 US HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6377
Practice Address - Country:US
Practice Address - Phone:937-393-4343
Practice Address - Fax:937-900-0641
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0268281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice