MEDICARE: DR. PHILLIP T IERO M.D., D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8490	ND
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	1910	ND
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	K9307	TX
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	18047	TX

General Provider Information

NPI Number	:	1497722664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP T IERO M.D., D.D.S.

Provider Business Mailing Address
First Line	:	6800 WEST LOOP S
Second Line	:	SUITE 350
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4528
Country	:	US
Telephone Number	:	713-665-9200
Fax Number	:	713-665-9206

Provider Business Practice Location Address
First Line	:	6800 WEST LOOP S
Second Line	:	SUITE 350
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4528
Country	:	US
Telephone Number	:	713-665-9200
Fax Number	:	713-665-9206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	02/22/2008

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Directions to “ DR. PHILLIP T IERO M.D., D.D.S.” Practice Location

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