Provider Demographics
NPI:1427551126
Name:JOHN P. BISSON, D.D.S., P.L.L.C
Entity Type:Organization
Organization Name:JOHN P. BISSON, D.D.S., P.L.L.C
Other - Org Name:BISSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BISSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-490-7752
Mailing Address - Street 1:305 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3144
Mailing Address - Country:US
Mailing Address - Phone:605-692-2820
Mailing Address - Fax:605-692-9116
Practice Address - Street 1:305 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3144
Practice Address - Country:US
Practice Address - Phone:605-692-2820
Practice Address - Fax:605-692-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD366261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164803805OtherINDIVIDUAL NPI