Provider Demographics
NPI:1497722664
Name:IERO, PHILLIP T (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:T
Last Name:IERO
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WEST LOOP S
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:713-665-9200
Mailing Address - Fax:713-665-9206
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:SUITE 350
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4528
Practice Address - Country:US
Practice Address - Phone:713-665-9200
Practice Address - Fax:713-665-9206
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND84901223S0112X
ND19101223S0112X
TXK93071223S0112X
TX180471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery