Provider Demographics
NPI:1902134307
Name:ALBERT R. BIRD DDS PS
Entity Type:Organization
Organization Name:ALBERT R. BIRD DDS PS
Other - Org Name:BIRD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-475-8934
Mailing Address - Street 1:4707 S JUNETT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6480
Mailing Address - Country:US
Mailing Address - Phone:253-475-8934
Mailing Address - Fax:253-472-0402
Practice Address - Street 1:4707 S JUNETT ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6480
Practice Address - Country:US
Practice Address - Phone:253-475-8934
Practice Address - Fax:253-472-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5399902Medicaid