Individual
PHILIP JAMES MIRISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
1223G0001X
General Practice Dentistry
Primary
12009980
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200189530A
—
IN
Enumeration date
11/02/2006
Last updated
07/08/2007
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