Provider Demographics
NPI:1356493233
Name:BYRON J. ROUND, D.D.S., P.C.
Entity Type:Organization
Organization Name:BYRON J. ROUND, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-482-3585
Mailing Address - Street 1:227 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5202
Mailing Address - Country:US
Mailing Address - Phone:860-482-3585
Mailing Address - Fax:860-482-4599
Practice Address - Street 1:227 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5202
Practice Address - Country:US
Practice Address - Phone:860-482-3585
Practice Address - Fax:860-482-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002043982Medicaid