Provider Demographics
NPI:1699851733
Name:BISHOP, JAMES C (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SOUTH FIR AVE.
Mailing Address - Street 2:P.O. BOX 1508
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428
Mailing Address - Country:US
Mailing Address - Phone:601-765-4355
Mailing Address - Fax:601-765-4745
Practice Address - Street 1:103 SOUTH FIR AVE.
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428
Practice Address - Country:US
Practice Address - Phone:601-765-4355
Practice Address - Fax:601-765-4745
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01751273Medicaid