Healthcare Provider Details

I. General information

NPI: 1225173214
Provider Name (Legal Business Name): WILLIAM MOSS BISHOP D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 BROOKWOOD MEDICAL CTR DR SUITE 21
BIRMINGHAM AL
35209-6874
US

IV. Provider business mailing address

2045 BROOKWOOD MEDICAL CTR DR SUITE 21
BIRMINGHAM AL
35209-6874
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-0892
  • Fax: 205-870-0894
Mailing address:
  • Phone: 205-870-0892
  • Fax: 205-870-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2838
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: