Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4014 | AL |
N | 1223P0300X | Periodontist | 4014 | AL |
NPI | 1033196159 |
---|---|
Provider Name | Dr. Frederick Charles Bisch |
First Address | Ft Gordon, GA 30905-5660 |
Second Address | Ft Gordon, GA 30905-5660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/07/2007 |