Provider Demographics
NPI:1710912241
Name:BIRTCHER, BRIAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:BIRTCHER
Suffix:
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 1:932 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5585
Mailing Address - Country:US
Mailing Address - Phone:928-536-5773
Mailing Address - Fax:928-536-7115
Practice Address - Street 1:932 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5585
Practice Address - Country:US
Practice Address - Phone:928-536-5773
Practice Address - Fax:928-536-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice