Healthcare Provider Details

I. General information

NPI: 1417180803
Provider Name (Legal Business Name): GABRIEL BIRD, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W MAIN ST STE 200
NORMAN OK
73069
US

IV. Provider business mailing address

227 W MAIN ST STE 200
NORMAN OK
73069-1310
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-2525
  • Fax: 405-321-2537
Mailing address:
  • Phone: 405-321-2525
  • Fax: 405-321-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number5936
License Number StateOK

VIII. Authorized Official

Name: DR. GABRIEL A BIRD
Title or Position: OWNER
Credential: DDS
Phone: 405-321-2525