Provider Demographics
NPI:1093736134
Name:BYROM, RICHARD A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BYROM
Suffix:JR
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 1:501 HARDING WAY W
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1612
Mailing Address - Country:US
Mailing Address - Phone:419-468-3358
Mailing Address - Fax:
Practice Address - Street 1:501 HARDING WAY W
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1612
Practice Address - Country:US
Practice Address - Phone:419-468-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0130461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171899Medicare ID - Type Unspecified