Provider Demographics
NPI:1548251531
Name:MCPHILLIPS, JOHN PATRICK (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:MCPHILLIPS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 CENTRAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5885
Mailing Address - Country:US
Mailing Address - Phone:817-283-5581
Mailing Address - Fax:817-283-8650
Practice Address - Street 1:2121 CENTRAL DR STE 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5885
Practice Address - Country:US
Practice Address - Phone:817-283-5581
Practice Address - Fax:817-283-8650
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery