Provider Demographics
NPI:1154565661
Name:AL DABAGH, BISHR (MD)
Entity type:Individual
Prefix:
First Name:BISHR
Middle Name:
Last Name:AL DABAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6542
Mailing Address - Country:US
Mailing Address - Phone:704-230-1302
Mailing Address - Fax:704-230-1284
Practice Address - Street 1:118 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6542
Practice Address - Country:US
Practice Address - Phone:704-230-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106561207N00000X, 207ND0101X
HIMD17679207N00000X, 207ND0101X
FLME142263207ND0101X
AZ49483207ND0101X
CAA125540207NS0135X
NC2019-01570207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology