Provider Demographics
NPI:1710020599
Name:BISHOP, JOHN LEE (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
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 1:3135 SPRINGBANK LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3360
Mailing Address - Country:US
Mailing Address - Phone:704-554-9199
Mailing Address - Fax:704-543-7343
Practice Address - Street 1:3135 SPRINGBANK LN
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3360
Practice Address - Country:US
Practice Address - Phone:704-554-9199
Practice Address - Fax:704-543-7343
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53491223G0001X
SC93121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice