Provider Demographics
NPI:1275689564
Name:SALLY A. BISHKO,DDS
Entity Type:Organization
Organization Name:SALLY A. BISHKO,DDS
Other - Org Name:RIVER STATION FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BISHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-223-2244
Mailing Address - Street 1:535 STONE CUTTERS WAY
Mailing Address - Street 2:SUITE 103
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:SUITE 103
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER
VT1012461Medicaid