Provider Demographics
NPI:1912063058
Name:BISHKO, SALLY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ANN
Last Name:BISHKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 STONE CUTTERS WAY
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3795
Mailing Address - Country:US
Mailing Address - Phone:802-223-2244
Mailing Address - Fax:802-223-1283
Practice Address - Street 1:535 STONE CUTTERS WAY
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3795
Practice Address - Country:US
Practice Address - Phone:802-223-2244
Practice Address - Fax:802-223-1283
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002483Medicaid