Provider Demographics
NPI:1033686142
Name:RED BIRD DENTAL LLC
Entity Type:Organization
Organization Name:RED BIRD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-305-2253
Mailing Address - Street 1:85 ARGONAUT STE 220
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4105
Mailing Address - Country:US
Mailing Address - Phone:949-305-2253
Mailing Address - Fax:
Practice Address - Street 1:839 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1782
Practice Address - Country:US
Practice Address - Phone:949-305-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental