Healthcare Provider Details

I. General information

NPI: 1063675767
Provider Name (Legal Business Name): JAMES DOUGLAS BIRD DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 S. UNION AVE #B16 HARBOR ORAL AND MAXILLOFACIAL SURGERY
TACOMA WA
98405-1333
US

IV. Provider business mailing address

2302 S. UNION AVE #B16 HARBOR ORAL AND MAXILLOFACIAL SURGERY
TACOMA WA
98405-1333
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3718
  • Fax:
Mailing address:
  • Phone: 253-759-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8275
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE 60220460
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: