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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