Provider Demographics
NPI:1588084206
Name:BISHARA DENTAL
Entity type:Organization
Organization Name:BISHARA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-227-1800
Mailing Address - Street 1:525 W PLEASANT RUN RD
Mailing Address - Street 2:200
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1576
Mailing Address - Country:US
Mailing Address - Phone:972-227-1800
Mailing Address - Fax:972-227-2771
Practice Address - Street 1:525 W PLEASANT RUN RD
Practice Address - Street 2:200
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1576
Practice Address - Country:US
Practice Address - Phone:972-227-1800
Practice Address - Fax:972-227-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229731223S0112X
TX210401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty