Provider Demographics
NPI:1124173810
Name:BISHOP, DAVID ROE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:K
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1104 N GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8621
Mailing Address - Country:US
Mailing Address - Phone:972-727-8249
Mailing Address - Fax:972-727-7681
Practice Address - Street 1:1104 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8621
Practice Address - Country:US
Practice Address - Phone:972-727-8249
Practice Address - Fax:972-727-7681
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice