Provider Demographics
NPI:1285767426
Name:BISHOP, ROBERT LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LESLIE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MOORE LN
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5006
Mailing Address - Country:US
Mailing Address - Phone:805-481-0214
Mailing Address - Fax:805-489-4783
Practice Address - Street 1:1558 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2236
Practice Address - Country:US
Practice Address - Phone:805-489-8444
Practice Address - Fax:805-489-4783
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice