Provider Demographics
NPI:1467720102
Name:BYRNSIDE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BYRNSIDE ENTERPRISES, INC.
Other - Org Name:MIDDLE TENNESSEE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-758-7511
Mailing Address - Street 1:40 W CALDWELL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2910
Mailing Address - Country:US
Mailing Address - Phone:615-758-7511
Mailing Address - Fax:615-827-0202
Practice Address - Street 1:40 W CALDWELL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2910
Practice Address - Country:US
Practice Address - Phone:615-758-7511
Practice Address - Fax:615-827-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty