Provider Demographics
NPI:1124443064
Name:BISHOP, RACHEL A (DDS)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 MARINA BAY DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-3918
Mailing Address - Country:US
Mailing Address - Phone:903-387-0728
Mailing Address - Fax:
Practice Address - Street 1:5718 MARINA BAY DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-3918
Practice Address - Country:US
Practice Address - Phone:903-387-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-02
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3225671223S0112X
TXS55611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery