Healthcare Provider Details

I. General information

NPI: 1922090620
Provider Name (Legal Business Name): GEORGE MICHAEL BIRD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 82 N GRAND VILLAGE CENTER #4
LANGLEY OK
74350-0189
US

IV. Provider business mailing address

PO BOX 189 GRAND VILLAGE CENTER #4
LANGLEY OK
74350-0189
US

V. Phone/Fax

Practice location:
  • Phone: 918-782-2009
  • Fax: 918-782-1042
Mailing address:
  • Phone: 918-782-2009
  • Fax: 918-782-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3091
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: