Individual
KEITH D BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2045 HIGHWAY 61 NORTH, PORT GIBSON, MS 39150-4262
(601) 437-3050
(601) 437-3051
Mailing address
PO BOX 741, PORT GIBSON, MS 39150-0741
(601) 437-3050
(601) 437-3051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3288-04
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09173729
—
MS
Enumeration date
09/01/2006
Last updated
07/08/2007
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