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NPI Code Detail

MEDICARE: DR. LIDA PISHBIN

MEDICARE:  DR. LIDA  PISHBIN
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
11223P0221XPediatric Dentistry37882TX
21223P0221XPediatric Dentistry110787CA

General Provider Information

NPI Number : 1861051948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LIDA PISHBIN
Provider Business Mailing Address
First Line : 7850 COMMUNICATIONS PKWY
Second Line :
City : PLANO
State : TX
Zip : 75024-6186
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2014 SKILLMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75206-7240
Country : US
Telephone Number : 469-314-2888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 09/19/2024

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