Provider Demographics
NPI:1679045629
Name:BIRK DENTAL LLC
Entity type:Organization
Organization Name:BIRK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-410-6016
Mailing Address - Street 1:8005 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2705
Mailing Address - Country:US
Mailing Address - Phone:314-968-8005
Mailing Address - Fax:
Practice Address - Street 1:8005 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2705
Practice Address - Country:US
Practice Address - Phone:314-968-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental