Provider Demographics
NPI:1558747808
Name:TRAVEL-DENT, BIRNS & BIRNS, PA
Entity Type:Organization
Organization Name:TRAVEL-DENT, BIRNS & BIRNS, PA
Other - Org Name:DRS. BRADLEY & ROBIN BIRNS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-680-2237
Mailing Address - Street 1:5121 SW 90TH AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3612
Mailing Address - Country:US
Mailing Address - Phone:954-680-2237
Mailing Address - Fax:954-680-4467
Practice Address - Street 1:5121 SW 90TH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3612
Practice Address - Country:US
Practice Address - Phone:954-680-2237
Practice Address - Fax:954-680-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10450122300000X
FL10512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty