1275689564 NPI number — SALLY A. BISHKO,DDS

Table of content: (NPI 1275689564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275689564 NPI number — SALLY A. BISHKO,DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALLY A. BISHKO,DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1275689564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 STONE CUTTERS WAY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05602-3795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-223-2244
Provider Business Mailing Address Fax Number:
802-223-1283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 STONE CUTTERS WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MONTPELIER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-3795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-223-2244
Provider Business Practice Location Address Fax Number:
802-223-1283
Provider Enumeration Date:
01/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BISHKO
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-223-2244

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  847 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012461 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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