Provider Demographics
NPI:1518997436
Name:BIRD, ROBERT JAMES JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:BIRD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROLLING HILLS DR
Mailing Address - Street 2:P.O. BOX 607
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2051
Mailing Address - Country:US
Mailing Address - Phone:860-364-0677
Mailing Address - Fax:860-364-1403
Practice Address - Street 1:60 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2481
Practice Address - Country:US
Practice Address - Phone:860-824-5101
Practice Address - Fax:860-824-9966
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0064551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020006455CT01OtherANTHEM BLUE BC/BS
CT190000956Medicare ID - Type Unspecified