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Provider Information for 1245319151

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

PHILIP JAMES MIRISE DDS

Gender: MALE

Individual NPI: 1245319151

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1245319151
Enumeration Date 2006-11-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 850 CEDAR LANE
FRANKLIN, IN 46131-1089
United States

Phone: 317-736-7476 | Fax: 317-736-1946
View Map External Link
Primary Practice Address 850 CEDAR LANE
FRANKLIN, IN 46131-1089
United States

Phone: 317-736-7476 | Fax: 317-736-1946
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID IN 200189530A
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice IN 12009980