Provider Demographics
NPI:1023483252
Name:BISHOP FAMILY DENTAL
Entity type:Organization
Organization Name:BISHOP FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-274-2500
Mailing Address - Street 1:2120 E 3900 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1771
Mailing Address - Country:US
Mailing Address - Phone:801-274-2500
Mailing Address - Fax:801-274-0590
Practice Address - Street 1:2120 E 3900 S
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1771
Practice Address - Country:US
Practice Address - Phone:801-274-2500
Practice Address - Fax:801-274-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78978139922305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization