Provider Demographics
NPI:1366607178
Name:BIRCH, DALLIN RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:RICHARD
Last Name:BIRCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5249
Mailing Address - Country:US
Mailing Address - Phone:520-285-7110
Mailing Address - Fax:
Practice Address - Street 1:15715 S 46TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0438
Practice Address - Country:US
Practice Address - Phone:480-598-5900
Practice Address - Fax:480-889-5859
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD76051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice