Provider Demographics
NPI:1063512176
Name:CARR, BYRON LEE (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:LEE
Last Name:CARR
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E LATHAM AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4361
Mailing Address - Country:US
Mailing Address - Phone:951-929-8863
Mailing Address - Fax:951-765-6234
Practice Address - Street 1:550 E LATHAM AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4361
Practice Address - Country:US
Practice Address - Phone:951-929-8863
Practice Address - Fax:951-765-6234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice