Healthcare Provider Details

I. General information

NPI: 1104884774
Provider Name (Legal Business Name): SUZANNE ELIZABETH BIRD DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE BIRD DAVIS DDS, MS

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 RIVERSTONE WAY SUITE 300
CHARLOTTE NC
28277
US

IV. Provider business mailing address

16607 RIVERSTONE WAY SUITE 300
CHARLOTTE NC
28277
US

V. Phone/Fax

Practice location:
  • Phone: 704-840-6803
  • Fax: 704-544-5003
Mailing address:
  • Phone: 704-840-6803
  • Fax: 704-544-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7109
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7109
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: