Healthcare Provider Details

I. General information

NPI: 1871322834
Provider Name (Legal Business Name): KAREN BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 7TH ST E
SAINT PAUL MN
55119-3419
US

IV. Provider business mailing address

4330 YORK AVE S
MINNEAPOLIS MN
55410-1452
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-0595
  • Fax:
Mailing address:
  • Phone: 608-385-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT166
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: