Healthcare Provider Details

I. General information

NPI: 1336549153
Provider Name (Legal Business Name): NABIL G BISHARA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6188 OXON HILL RD STE 200
OXON HILL MD
20745-3157
US

IV. Provider business mailing address

6188 OXON HILL RD STE 200
OXON HILL MD
20745-3157
US

V. Phone/Fax

Practice location:
  • Phone: 301-567-3122
  • Fax: 301-567-5234
Mailing address:
  • Phone: 703-938-7615
  • Fax: 703-242-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414607
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: