Provider Demographics
NPI:1487131488
Name:MCPHILLIPS, SYDNEY RAE (DDS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RAE
Last Name:MCPHILLIPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 SHENANDOAH ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6548
Mailing Address - Country:US
Mailing Address - Phone:612-210-7100
Mailing Address - Fax:
Practice Address - Street 1:1090 SHINGLE CREEK XING
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2684
Practice Address - Country:US
Practice Address - Phone:651-724-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice