Provider Demographics
NPI:1245418292
Name:BYRAM, JEFF H (DDS)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:H
Last Name:BYRAM
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 1:408 WEST VINE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-268-7000
Mailing Address - Fax:501-279-3606
Practice Address - Street 1:408 WEST VINE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-7000
Practice Address - Fax:501-279-3606
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3108204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12801679Medicaid
ARU49977Medicare UPIN