Provider Demographics
NPI:1669640595
Name:PHILLIP T. IERO, MD, DDS, PA
Entity Type:Organization
Organization Name:PHILLIP T. IERO, MD, DDS, PA
Other - Org Name:BELLAIRE FACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:IERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:713-665-9200
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9307261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery