Provider Demographics
NPI:1538103544
Name:BISHOP, JOHN LYMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LYMAN
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8949
Mailing Address - Country:US
Mailing Address - Phone:435-840-2016
Mailing Address - Fax:
Practice Address - Street 1:1204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9540
Practice Address - Country:US
Practice Address - Phone:435-882-8600
Practice Address - Fax:435-882-8481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52595841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT82398OtherPEHP
UT5259849901001OtherBLUE CROSS BLUE SHIELD
UT1745643OtherUNITED CONCORDIA