Individual
DR. MARK ROBERT BIRMINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4501 E SNIDER DR, WASILLA, AK 99654-7604
(907) 376-8400
(907) 376-8402
Mailing address
4501 E SNIDER DR, WASILLA, AK 99654-7604
(907) 376-8400
(907) 376-8402
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
106211
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003845
—
AK
Enumeration date
02/17/2016
Last updated
02/17/2016
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