Healthcare Provider Details

I. General information

NPI: 1992192926
Provider Name (Legal Business Name): GEOFFREY BIRD D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6947 BELLAIRE DR
NEW ORLEANS LA
70124-1549
US

IV. Provider business mailing address

6947 BELLAIRE DR
NEW ORLEANS LA
70124-1549
US

V. Phone/Fax

Practice location:
  • Phone: 504-296-5435
  • Fax:
Mailing address:
  • Phone: 504-296-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6544
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: