Provider Demographics
NPI:1336549153
Name:BISHARA, NABIL G (DDS)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:G
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 1:6188 OXON HILL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3157
Mailing Address - Country:US
Mailing Address - Phone:703-938-7615
Mailing Address - Fax:703-242-9417
Practice Address - Street 1:6188 OXON HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3157
Practice Address - Country:US
Practice Address - Phone:301-567-3122
Practice Address - Fax:301-567-5234
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157671223G0001X
VA0401414607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD093956100Medicaid