Provider Demographics
NPI:1457493124
Name:BISHOP, CATHERINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 38TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6705
Mailing Address - Country:US
Mailing Address - Phone:309-762-6900
Mailing Address - Fax:309-762-6523
Practice Address - Street 1:4720 38TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6705
Practice Address - Country:US
Practice Address - Phone:309-762-6900
Practice Address - Fax:309-762-6523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190203361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics