Provider Demographics
NPI:1477719797
Name:BIRD, ZACHARY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:A
Last Name:BIRD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 S JUNETT ST STE A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6480
Mailing Address - Country:US
Mailing Address - Phone:253-475-8934
Mailing Address - Fax:253-472-0402
Practice Address - Street 1:4707 S JUNETT ST STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6480
Practice Address - Country:US
Practice Address - Phone:253-475-8934
Practice Address - Fax:253-472-0402
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice