Provider Demographics
NPI:1366802985
Name:BIRK, PAVANDEEP
Entity type:Individual
Prefix:DR
First Name:PAVANDEEP
Middle Name:
Last Name:BIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 E BAYAUD AVE
Mailing Address - Street 2:UNIT H
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14401 E BAYAUD AVE
Practice Address - Street 2:UNIT H
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1415
Practice Address - Country:US
Practice Address - Phone:303-364-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO00202923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program