Provider Demographics
NPI:1437383759
Name:BISHARA DENTAL
Entity Type:Organization
Organization Name:BISHARA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-742-7220
Mailing Address - Street 1:46641 N BLACK CANYON HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6941
Mailing Address - Country:US
Mailing Address - Phone:623-742-7220
Mailing Address - Fax:623-742-7332
Practice Address - Street 1:46641 N BLACK CANYON HWY STE 7
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6941
Practice Address - Country:US
Practice Address - Phone:623-742-7220
Practice Address - Fax:623-742-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty