Provider Demographics
NPI:1881757011
Name:MCIVER, PHILLIP S (DDS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:S
Last Name:MCIVER
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 1:304 IONA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-1618
Mailing Address - Country:US
Mailing Address - Phone:910-535-4316
Mailing Address - Fax:910-535-4306
Practice Address - Street 1:304 IONA ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1618
Practice Address - Country:US
Practice Address - Phone:910-535-4316
Practice Address - Fax:910-535-4306
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051257122300000X
NC8366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051257OtherLICENCE NUMBER
NC5907363Medicaid