Provider Demographics
NPI:1871814541
Name:MISHREKY, BISHOY (DDS)
Entity type:Individual
Prefix:
First Name:BISHOY
Middle Name:
Last Name:MISHREKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-1505
Mailing Address - Country:US
Mailing Address - Phone:210-432-0909
Mailing Address - Fax:
Practice Address - Street 1:4847 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-1505
Practice Address - Country:US
Practice Address - Phone:210-432-0909
Practice Address - Fax:210-432-2070
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00255621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice