LARRY GORDON PHILLIPS D.M.D. NPI 1366458960

NPI Information

  • NPI: 1366458960
  • Provider Name: LARRY GORDON PHILLIPS, D.M.D.
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4514 OUTER LOOP
    LOUISVILLE, KY
    ZIP 40219
  • Phone: (502) 969-9264

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NPI Details

Larry Gordon Phillips, D.M.D. is a pediatric dentistry dentist in Louisville, KY. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. Larry Gordon Phillips, D.M.D. NPI is 1366458960. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4514 OUTER LOOP
LOUISVILLE, KY
ZIP 40219-857
Phone: (502) 969-9264
Fax: (502) 969-9535

The NPI 1366458960 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/1/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0221XDentistPediatric Dentistry4510KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
160045101MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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