Provider Demographics
NPI:1235323684
Name:BISHARA, SHERIF K
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:K
Last Name:BISHARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WEST WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2912
Mailing Address - Country:US
Mailing Address - Phone:603-624-4147
Mailing Address - Fax:603-669-0129
Practice Address - Street 1:26 WEST WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2912
Practice Address - Country:US
Practice Address - Phone:603-624-4147
Practice Address - Fax:603-669-0129
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist