Provider Demographics
NPI:1205213295
Name:BYRD, MEREDITH GENTRY LASATER (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:GENTRY LASATER
Last Name:BYRD
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 WAKEFIELD PINES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8597
Mailing Address - Country:US
Mailing Address - Phone:919-488-0170
Mailing Address - Fax:
Practice Address - Street 1:2800 WAKEFIELD PINES DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8597
Practice Address - Country:US
Practice Address - Phone:919-488-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10107122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205213295Medicaid