Provider Demographics
NPI:1215153812
Name:BIRKY, HAROLD JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:JOHN
Last Name:BIRKY
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 1:3115 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3099
Mailing Address - Country:US
Mailing Address - Phone:847-746-8622
Mailing Address - Fax:847-746-8215
Practice Address - Street 1:3115 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-3099
Practice Address - Country:US
Practice Address - Phone:847-746-8622
Practice Address - Fax:847-746-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019013952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist