Provider Demographics
NPI:1710950225
Name:BIRD, GEORGE GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GREGORY
Last Name:BIRD
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 1:297 SNOWY OWL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1243
Mailing Address - Country:US
Mailing Address - Phone:907-452-1881
Mailing Address - Fax:
Practice Address - Street 1:1717 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5926
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3837
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice