Provider Demographics
NPI:1386839363
Name:MAX D. BIRD, D.D.S., INC.
Entity Type:Organization
Organization Name:MAX D. BIRD, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-437-8612
Mailing Address - Street 1:10124 S SHERIDAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6742
Mailing Address - Country:US
Mailing Address - Phone:918-528-6555
Mailing Address - Fax:
Practice Address - Street 1:10124 S SHERIDAN RD STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6742
Practice Address - Country:US
Practice Address - Phone:918-528-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty