Healthcare Provider Details

I. General information

NPI: 1063346070
Provider Name (Legal Business Name): JASMINE BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 PAOLI PIKE
WEST CHESTER PA
19380-6123
US

IV. Provider business mailing address

1500 HAMILTON ST APT 1142
PHILADELPHIA PA
19130-2555
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-7066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: