Provider Demographics
NPI:1689849325
Name:SUZANNE E BIRD DDS MS PA
Entity Type:Organization
Organization Name:SUZANNE E BIRD DDS MS PA
Other - Org Name:BIRD PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:704-840-6803
Mailing Address - Street 1:16607 RIVERSTONE WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5746
Mailing Address - Country:US
Mailing Address - Phone:704-840-6803
Mailing Address - Fax:
Practice Address - Street 1:16607 RIVERSTONE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5746
Practice Address - Country:US
Practice Address - Phone:704-840-6803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental