Provider Demographics
NPI:1104679448
Name:PHILLIP MCIVER DDS PA
Entity type:Organization
Organization Name:PHILLIP MCIVER DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-628-7166
Mailing Address - Street 1:304 IONA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-1618
Mailing Address - Country:US
Mailing Address - Phone:910-628-7166
Mailing Address - Fax:
Practice Address - Street 1:304 IONA ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1618
Practice Address - Country:US
Practice Address - Phone:910-628-7166
Practice Address - Fax:910-535-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty