Provider Demographics
NPI:1225797731
Name:BISBAS, JAMES SPENCER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SPENCER
Last Name:BISBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 CARMEL COUNTRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2171
Mailing Address - Country:US
Mailing Address - Phone:858-755-5363
Mailing Address - Fax:
Practice Address - Street 1:12750 CARMEL COUNTRY RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2171
Practice Address - Country:US
Practice Address - Phone:858-755-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1023111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty