| Doctor Name: | JASON S BISHOP |
| NPI Number: | 1508935602 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS |
| License Number: | 43758 |
| Business Practice Address: | 85 Sierra Park Rd Mammoth Lakes, CA - 935462073 |
| Business Phone Number: | 7609244007 |
| Business Fax Number: | 7609244048 |
| Mailing Address: | 155 W Glaucus St Unit C, ENCINITAS |
| State: | CA |
| Postal Code: | 920241416 |
| Phone Number: | 7607101369 |
| Fax Number: | |
| NPI Enumeration Date: | 11/06/2006 |
| NPI Last Update Date: | 03/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 43758 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |