Healthcare Provider Details

I. General information

NPI: 1437383759
Provider Name (Legal Business Name): BISHARA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46641 N BLACK CANYON HWY STE 7
NEW RIVER AZ
85087-6941
US

IV. Provider business mailing address

46641 N BLACK CANYON HWY STE 7
NEW RIVER AZ
85087-6941
US

V. Phone/Fax

Practice location:
  • Phone: 623-742-7220
  • Fax: 623-742-7332
Mailing address:
  • Phone: 623-742-7220
  • Fax: 623-742-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7133
License Number StateAZ

VIII. Authorized Official

Name: DR. HELEN BISHARA
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 623-742-7220