1538103544 NPI number — DR. JOHN LYMAN BISHOP DMD

Table of content: DR. JOHN LYMAN BISHOP DMD (NPI 1538103544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538103544 NPI number — DR. JOHN LYMAN BISHOP DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHOP
Provider First Name:
JOHN
Provider Middle Name:
LYMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538103544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5907 WINDSONG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANSBURY PARK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84074-8949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-840-2016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOOELE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84074-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-882-8600
Provider Business Practice Location Address Fax Number:
435-882-8481
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5259584 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82398 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5259849901001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1745643 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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