Provider Demographics
NPI:1518088277
Name:BISHOP, ALTON CORDER (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ALTON
Middle Name:CORDER
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DDS, MSD
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Mailing Address - Street 1:5209 HERITAGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5996
Mailing Address - Country:US
Mailing Address - Phone:970-390-2121
Mailing Address - Fax:682-503-8505
Practice Address - Street 1:34237 HWY 6 STE 105
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-926-2666
Practice Address - Fax:970-926-9474
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics