Organization
MERCHANTS WALK DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN BISHARA DDS (OWNER)
(678) 754-4673
Entity
Organization
Contact information
Practice address
1344 E COBB DR STE 100, MARIETTA, GA 30068-2726
(770) 961-5055
Mailing address
3760 OLD COLLEGE WAY, MARIETTA, GA 30062-5964
(678) 754-4673
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336163955
NPI
—
Enumeration date
07/13/2022
Last updated
07/13/2022
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