Provider Demographics
NPI:1720200207
Name:BISHOP, MARVIN DAVID III (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DAVID
Last Name:BISHOP
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 LILY FLAGG RD SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3040
Mailing Address - Country:US
Mailing Address - Phone:256-881-4580
Mailing Address - Fax:256-881-4585
Practice Address - Street 1:112 LILY FLAGG RD SW
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3040
Practice Address - Country:US
Practice Address - Phone:256-881-4580
Practice Address - Fax:256-881-4585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice