Provider Demographics
NPI:1801573985
Name:BISHOP, LUCAS CLARK (DMD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:CLARK
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 STOKES RD
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9570
Mailing Address - Country:US
Mailing Address - Phone:251-209-9754
Mailing Address - Fax:
Practice Address - Street 1:2817 LOOP 250 FRONTAGE RD
Practice Address - Street 2:STE B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:251-209-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist