Healthcare Provider Details

I. General information

NPI: 1588697015
Provider Name (Legal Business Name): PHILLIP T. IERO, M.D.,D.D.S., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N 6TH ST
BISMARCK ND
58501-4416
US

IV. Provider business mailing address

416 N 6TH ST
BISMARCK ND
58501-4416
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-4000
  • Fax: 701-255-1992
Mailing address:
  • Phone: 701-255-4000
  • Fax: 701-255-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLENE ANN SCHMALTZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 70125540000