Provider Demographics
NPI:1710132030
Name:PHILLIP S. MCIVER DDS PA
Entity Type:Organization
Organization Name:PHILLIP S. MCIVER DDS PA
Other - Org Name:BRIER CREEK CENTER FOR IMPLANTS & ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANNIE
Authorized Official - Middle Name:TEASLEY
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-251-8036
Mailing Address - Street 1:7920 ACC BLVD.
Mailing Address - Street 2:STE. 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8744
Mailing Address - Country:US
Mailing Address - Phone:919-251-8036
Mailing Address - Fax:919-251-8338
Practice Address - Street 1:7920 ACC BLVD.
Practice Address - Street 2:STE. 130
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8744
Practice Address - Country:US
Practice Address - Phone:919-251-8036
Practice Address - Fax:919-251-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8366122300000X, 1223S0112X
NY051257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907363Medicaid
NC5950613Medicaid