Provider Demographics
NPI:1154536498
Name:BISHOP, F WATT (DDS,MS)
Entity type:Individual
Prefix:
First Name:F
Middle Name:WATT
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1218
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1218
Mailing Address - Country:US
Mailing Address - Phone:662-234-4822
Mailing Address - Fax:662-234-9032
Practice Address - Street 1:306 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4012
Practice Address - Country:US
Practice Address - Phone:662-234-4822
Practice Address - Fax:662-234-9032
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR-002-761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics