Provider Demographics
NPI:1699703652
Name:BISHOP, WAYNE B (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:B
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 1:2219 S LOOP 288
Mailing Address - Street 2:#215
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4991
Mailing Address - Country:US
Mailing Address - Phone:940-591-9700
Mailing Address - Fax:940-387-7982
Practice Address - Street 1:2219 S LOOP 288
Practice Address - Street 2:#215
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4991
Practice Address - Country:US
Practice Address - Phone:940-591-9700
Practice Address - Fax:940-387-7982
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX134361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice