Provider Demographics
NPI:1093042582
Name:BISHARA, MENA (DMD)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:BISHARA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 RICHMOND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6227
Mailing Address - Country:US
Mailing Address - Phone:832-767-3331
Mailing Address - Fax:832-538-0343
Practice Address - Street 1:6060 RICHMOND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6227
Practice Address - Country:US
Practice Address - Phone:832-767-3331
Practice Address - Fax:832-538-0343
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice