Provider Demographics
NPI:1588697015
Name:PHILLIP T. IERO, M.D.,D.D.S., PC
Entity type:Organization
Organization Name:PHILLIP T. IERO, M.D.,D.D.S., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHMALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7012-554-0000
Mailing Address - Street 1:416 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4416
Mailing Address - Country:US
Mailing Address - Phone:701-255-4000
Mailing Address - Fax:701-255-1992
Practice Address - Street 1:416 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4416
Practice Address - Country:US
Practice Address - Phone:701-255-4000
Practice Address - Fax:701-255-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty