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General NPI Number Information
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NPI Number | 1578660213
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Entity Type | Individual
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Provider Name | JOHN PHILLIP IREY DDS
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Gender | Male
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 4010 S CHURCH DR
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City | NEW BERLIN
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State | WI
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Zip | 53151-5608
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Country | US
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Telephone | 262-784-2449
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Fax | 262-784-7873
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | CHESAPEAKE BEACH
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State | MD
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Zip | 20732-0158
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Country | US
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Telephone | 301-481-6664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1001038-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8088
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD5248
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1001038-15
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License Number State | WI
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