Provider Demographics
NPI:1750303707
Name:BIRD, ALBERT ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ROY
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 1:4707 S JUNETT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6480
Mailing Address - Country:US
Mailing Address - Phone:253-475-8934
Mailing Address - Fax:253-472-0402
Practice Address - Street 1:4707 S JUNETT ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6480
Practice Address - Country:US
Practice Address - Phone:253-475-8934
Practice Address - Fax:253-472-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice