Provider Demographics
NPI:1306922620
Name:BIRD, DENNIS RICHARD (DPH)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:BIRD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1246
Mailing Address - Country:US
Mailing Address - Phone:918-456-8534
Mailing Address - Fax:918-456-1323
Practice Address - Street 1:2028 MAHANEY AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5783
Practice Address - Country:US
Practice Address - Phone:918-431-0555
Practice Address - Fax:918-431-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist