Provider Demographics
NPI:1053322271
Name:BYRNE, STEPHEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:BYRNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR#1 BOX #1060
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-0000
Mailing Address - Country:US
Mailing Address - Phone:918-225-0104
Mailing Address - Fax:
Practice Address - Street 1:ALLEN DENTAL CLINIC
Practice Address - Street 2:6037 BESSINGER RD
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-0000
Practice Address - Country:US
Practice Address - Phone:580-442-6106
Practice Address - Fax:580-442-7150
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK36591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice