Provider Demographics
NPI:1003801978
Name:BIRD, ELIOT WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:WILLIAM
Last Name:BIRD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 CHARTER HILL CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7740
Mailing Address - Country:US
Mailing Address - Phone:804-550-1222
Mailing Address - Fax:804-550-0753
Practice Address - Street 1:10640 CHARTER HILL CT
Practice Address - Street 2:SUITE 101
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7740
Practice Address - Country:US
Practice Address - Phone:804-550-1222
Practice Address - Fax:804-550-0753
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice