Individual
DR. LARISSA KYLE BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
3181 PRAIRIE ST SW, SUITE 106, GRANDVILLE, MI 49418-2097
(616) 531-0360
(616) 531-2810
Mailing address
813 CHIPPEWA DR SE, GRAND RAPIDS, MI 49506-3319
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901018015
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4487030
—
MI
01
—
D180150
BCBS
MI
Enumeration date
07/19/2006
Last updated
07/08/2007
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