| Organization Name: | UPPER VALLEY DENTAL CENTER |
| NPI Number: | 1093195117 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA BERNICE PHILLIPS (DENTIST) |
| Mailing Address: | 8648 Old Troy Pike Huber Heights |
| State: | OH US |
| Postal Code: | 454241069 |
| Phone Number: | 9372364360 |
| Fax Number: | 9372364365 |
| NPI Enumeration Date: | 06/03/2015 |
| NPI Last Update Date: | 06/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 30019980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |