Provider Demographics
NPI:1063292738
Name:BISHOP DENTAL, LLC
Entity type:Organization
Organization Name:BISHOP DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-879-8381
Mailing Address - Street 1:209 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2404
Mailing Address - Country:US
Mailing Address - Phone:620-424-4311
Mailing Address - Fax:
Practice Address - Street 1:209 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2404
Practice Address - Country:US
Practice Address - Phone:620-424-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE VISTA DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty