Healthcare Provider Details

I. General information

NPI: 1154536498
Provider Name (Legal Business Name): F WATT BISHOP DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S LAMAR BLVD
OXFORD MS
38655-4012
US

IV. Provider business mailing address

P O BOX 1218
OXFORD MS
38655-1218
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-4822
  • Fax: 662-234-9032
Mailing address:
  • Phone: 662-234-4822
  • Fax: 662-234-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberOR-002-76
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: