MEDICARE: BISHARA DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7133	AZ

General Provider Information

NPI Number	:	1437383759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISHARA DENTAL

Provider Business Mailing Address
First Line	:	46641 N BLACK CANYON HWY STE 7
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6941
Country	:	US
Telephone Number	:	623-742-7220
Fax Number	:	623-742-7332

Provider Business Practice Location Address
First Line	:	46641 N BLACK CANYON HWY STE 7
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6941
Country	:	US
Telephone Number	:	623-742-7220
Fax Number	:	623-742-7332

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. HELEN BISHARA
Credential	:	DMD
Telephone Number	:	623-742-7220

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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Directions to “BISHARA DENTAL ” Practice Location

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