Provider Demographics
NPI:1447785571
Name:BYRD, IKETRIA (DDS)
Entity Type:Individual
Prefix:
First Name:IKETRIA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
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:PO BOX 6003
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-6003
Mailing Address - Country:US
Mailing Address - Phone:318-537-4492
Mailing Address - Fax:
Practice Address - Street 1:5201 VETERANS MEMORIAL BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5122
Practice Address - Country:US
Practice Address - Phone:504-273-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32797122300000X
FL25769122300000X
ALD-0006885-C11223G0001X
LA7471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty