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General NPI Number Information
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NPI Number | 1932833217
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Entity Type | Organization
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Legal Business Name | MERCHANTS WALK DENTAL PC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1344 E COBB DR STE 100
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City | MARIETTA
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State | GA
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Zip | 30068-2726
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Country | US
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Telephone | 770-961-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 3760 OLD COLLEGE WAY
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City | MARIETTA
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State | GA
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Zip | 30062-5964
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Country | US
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Telephone | 678-754-4673
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN BISHARA
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Credential | DDS
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Telephone | 678-754-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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