Healthcare Provider Details

I. General information

NPI: 1578655635
Provider Name (Legal Business Name): CHRISTINE BISHOP DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E 116TH ST 102
CARMEL IN
46032-3508
US

IV. Provider business mailing address

2000 E 116TH ST 102
CARMEL IN
46032-3508
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-0866
  • Fax: 317-574-0867
Mailing address:
  • Phone: 317-574-0866
  • Fax: 317-574-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009748
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: