Provider Demographics
NPI:1578660213
Name:IREY, JOHN PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:IREY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-0158
Mailing Address - Country:US
Mailing Address - Phone:301-481-6664
Mailing Address - Fax:
Practice Address - Street 1:4010 S CHURCH DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5608
Practice Address - Country:US
Practice Address - Phone:262-784-2449
Practice Address - Fax:262-784-7873
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001038-15122300000X, 1223G0001X
MD8088122300000X
NMDD52481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist