Provider Demographics
NPI:1003543026
Name:BIRD, PAULA LEA (RDH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LEA
Last Name:BIRD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:LEA
Other - Last Name:HOEFS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30227 SELMA LEA RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-9727
Mailing Address - Country:US
Mailing Address - Phone:715-566-1492
Mailing Address - Fax:
Practice Address - Street 1:24663 ANGELINE AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-9246
Practice Address - Country:US
Practice Address - Phone:715-349-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4113-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist