Provider Demographics
NPI:1104356450
Name:SHIERE, PHILIP CLIFTON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CLIFTON
Last Name:SHIERE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COOLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1215
Mailing Address - Country:US
Mailing Address - Phone:603-817-1624
Mailing Address - Fax:
Practice Address - Street 1:66 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1889
Practice Address - Country:US
Practice Address - Phone:413-565-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18579811223E0200X, 1223G0001X
CT12513390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice