Provider Demographics
NPI:1437369279
Name:D. WAYNE BIRCH, D.D.S., P.C.
Entity Type:Organization
Organization Name:D. WAYNE BIRCH, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-875-3658
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-0309
Mailing Address - Country:US
Mailing Address - Phone:307-875-3658
Mailing Address - Fax:307-875-5846
Practice Address - Street 1:661 UINTA DR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5031
Practice Address - Country:US
Practice Address - Phone:307-875-3658
Practice Address - Fax:307-875-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty