Provider Demographics
NPI:1528231784
Name:BYRD, BYRON K (DDS)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:K
Last Name:BYRD
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 1:11045 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7719
Mailing Address - Country:US
Mailing Address - Phone:301-582-3010
Mailing Address - Fax:301-582-5365
Practice Address - Street 1:11045 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7719
Practice Address - Country:US
Practice Address - Phone:301-582-3010
Practice Address - Fax:301-582-5365
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD58931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice