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Organization
CEDAR LANE FAMILY DENTISTRY PC
Active
Organization
CEDAR LANE FAMILY DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP JAMES MIRISE DDS (DENTIST CEO)
(317) 736-7476
Entity
Organization
Contact information
Practice address
850 CEDAR LANE, FRANKLIN, IN 46131-1089
(317) 736-7476
(317) 736-1946
Mailing address
850 CEDAR LANE, FRANKLIN, IN 46131-1089
(317) 736-7476
(317) 736-1946
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009980
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200189530A
—
IN
Enumeration date
12/11/2006
Last updated
06/28/2012
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