Provider Demographics
NPI:1134292543
Name:BIRKS, LAURA LEE (RDH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:BIRKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 PLEASANT MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-262-0773
Mailing Address - Fax:
Practice Address - Street 1:1712 CLUBHOUSE RD 106
Practice Address - Street 2:DR ZACKO & ASSOC
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-471-6600
Practice Address - Fax:703-471-1675
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist