Provider Demographics
NPI:1003924473
Name:BYRON, MARK A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BYRON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2649
Mailing Address - Country:US
Mailing Address - Phone:304-485-4600
Mailing Address - Fax:304-485-4618
Practice Address - Street 1:2601 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2649
Practice Address - Country:US
Practice Address - Phone:304-485-4600
Practice Address - Fax:304-485-4618
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics