Provider Demographics
NPI:1952381899
Name:PHILLIPS, NATHAN ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALEXANDER
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5095
Mailing Address - Country:US
Mailing Address - Phone:605-242-0107
Mailing Address - Fax:605-242-0145
Practice Address - Street 1:301 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-242-0107
Practice Address - Fax:605-242-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093661223S0112X
SDD11401223S0112X
TX218711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1548304710OtherBC/BS OF SD
IA1548304710OtherBC/BS OF IA
SD1548304710Medicaid
SD1548304710OtherDELTA DENTAL OF SD
IA1548304710Medicaid
IA1548304710OtherDELTA DENTAL OF IOWA
NE91201365400Medicaid