Provider Demographics
NPI:1336229327
Name:BISHARA, FIRAS (DDS)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:
Last Name:BISHARA
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 1:525 W PLEASANT RUN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1576
Mailing Address - Country:US
Mailing Address - Phone:972-227-1800
Mailing Address - Fax:972-227-2771
Practice Address - Street 1:525 W PLEASANT RUN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1576
Practice Address - Country:US
Practice Address - Phone:972-227-1800
Practice Address - Fax:972-227-2771
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154740808Medicaid