Provider Demographics
NPI:1578903407
Name:BYRD, JILLIAN LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEIGH
Last Name:BYRD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-8111
Mailing Address - Country:US
Mailing Address - Phone:843-221-4746
Mailing Address - Fax:843-221-4750
Practice Address - Street 1:3535 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-8111
Practice Address - Country:US
Practice Address - Phone:843-221-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice