MEDICARE: DR. LIDA PISHBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	37882	TX
2	1223P0221X	Pediatric Dentistry	110787	CA

General Provider Information

NPI Number	:	1861051948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIDA PISHBIN

Provider Business Mailing Address
First Line	:	7850 COMMUNICATIONS PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7240
Country	:	US
Telephone Number	:	469-314-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	09/19/2024

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Directions to “ DR. LIDA PISHBIN ” Practice Location

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