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General NPI Number Information
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NPI Number | 1558330480
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Entity Type | Individual
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Provider Name | JACK H BISHOP D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 613 DUTCHMANS LN
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City | EASTON
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State | MD
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Zip | 21601-3345
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Country | US
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Telephone | 410-822-7710
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Fax | 410-763-8929
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Provider Business Mailing Address
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Address Line | 5019 REED RD
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City | OXFORD
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State | MD
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Zip | 21654-1518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4904
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License Number State | MD
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