Provider Demographics
NPI:1922090620
Name:BIRD, GEORGE MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:BIRD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:GRAND VILLAGE CENTER #4
Mailing Address - City:LANGLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74350-0189
Mailing Address - Country:US
Mailing Address - Phone:918-782-2009
Mailing Address - Fax:918-782-1042
Practice Address - Street 1:HWY 82 N
Practice Address - Street 2:GRAND VILLAGE CENTER #4
Practice Address - City:LANGLEY
Practice Address - State:OK
Practice Address - Zip Code:74350-0189
Practice Address - Country:US
Practice Address - Phone:918-782-2009
Practice Address - Fax:918-782-1042
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice