Provider Demographics
NPI:1235349010
Name:CHILDERS, JOHN BISHOP (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BISHOP
Last Name:CHILDERS
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 1:3960 EL CAMINO AVE
Mailing Address - Street 2:STE #3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6534
Mailing Address - Country:US
Mailing Address - Phone:916-483-3234
Mailing Address - Fax:916-483-7012
Practice Address - Street 1:3960 EL CAMINO AVE
Practice Address - Street 2:STE #3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6534
Practice Address - Country:US
Practice Address - Phone:916-483-3234
Practice Address - Fax:916-483-7012
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19851Medicare ID - Type UnspecifiedDENTAL LICENSE