Organization
BLOOMFIELD FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP JAMES MIRISE DDS (DENTIST)
(317) 670-6026
Entity
Organization
Contact information
Practice address
200 E MAIN ST STE 3, BLOOMFIELD, IN 47424-1452
(812) 384-3736
Mailing address
3325 W COUNTY ROAD 100 N, BARGERSVILLE, IN 46106-9582
(317) 670-6026
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/30/2024
Last updated
04/30/2024
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