Provider Demographics
NPI:1972393155
Name:BIRCH, JADEN WAYNE (DMD)
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:WAYNE
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 1:1117 N MILT PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-2321
Mailing Address - Country:US
Mailing Address - Phone:405-382-8282
Mailing Address - Fax:405-716-4005
Practice Address - Street 1:1117 N MILT PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2321
Practice Address - Country:US
Practice Address - Phone:405-382-8282
Practice Address - Fax:405-716-4005
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice