Provider Demographics
NPI:1710214200
Name:BISHARA, SUZY (DDS)
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:BISHARA
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 1:400 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5980
Mailing Address - Country:US
Mailing Address - Phone:770-916-5362
Mailing Address - Fax:678-247-7829
Practice Address - Street 1:1840 N LEE TREVINO DR
Practice Address - Street 2:SUITE 405-407
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4136
Practice Address - Country:US
Practice Address - Phone:800-920-9947
Practice Address - Fax:678-904-5666
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25092122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist