Shima Phoenix, DMD

NPI #1588040976 in Mount Vernon, Illinois

Provider Information

NPI Number: 1588040976
Entity Type: Individual
Name: Shima Phoenix, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DMD
Enumeration Date: Aug 7, 2015
Last Updated: Aug 20, 2015

Practice Location

Address: 4201 BROADWAY ST
City: Mount Vernon
State: Illinois
ZIP Code: 62864-2282
Phone: (618) 241-0997

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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