Provider Demographics
NPI:1518167675
Name:BYERS, SEAN ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ROBERT
Last Name:BYERS
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 1:131 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1209
Mailing Address - Country:US
Mailing Address - Phone:740-420-0755
Mailing Address - Fax:740-420-0754
Practice Address - Street 1:131 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1209
Practice Address - Country:US
Practice Address - Phone:740-420-0755
Practice Address - Fax:740-420-0754
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2747433Medicaid
OH3142969Medicaid