Provider Demographics
NPI:1700945870
Name:BISESE, MARY ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:BISESE
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 1:1301 J ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3251
Mailing Address - Country:US
Mailing Address - Phone:360-676-7130
Mailing Address - Fax:360-676-1125
Practice Address - Street 1:1301 J ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3251
Practice Address - Country:US
Practice Address - Phone:360-676-7130
Practice Address - Fax:360-676-1125
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5018684Medicaid