Provider Demographics
NPI:1356344360
Name:MCBIRNEY, JOHN BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRUCE
Last Name:MCBIRNEY
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 1:158 SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022
Mailing Address - Country:US
Mailing Address - Phone:650-948-0786
Mailing Address - Fax:650-948-4006
Practice Address - Street 1:158 SECOND ST.
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022
Practice Address - Country:US
Practice Address - Phone:650-948-0786
Practice Address - Fax:650-948-4006
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice