| Doctor Name: | MARK W BIRD |
| NPI Number: | 1134392392 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | DN00000257 |
| Business Practice Address: | 214 Washington Ave. Orting, WA - 98360 |
| Business Phone Number: | 2537590350 |
| Business Fax Number: | |
| Mailing Address: | Po Box 174, ORTING |
| State: | WA |
| Postal Code: | 983600174 |
| Phone Number: | 2537590350 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2008 |
| NPI Last Update Date: | 04/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN00000257 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |