Provider Demographics
NPI:1386499945
Name:BIRK DENTAL PLLC
Entity type:Organization
Organization Name:BIRK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:605-480-2985
Mailing Address - Street 1:4550 E. BELL ROAD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:650-480-2985
Mailing Address - Fax:
Practice Address - Street 1:4550 E BELL RD STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9383
Practice Address - Country:US
Practice Address - Phone:602-730-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental