Provider Demographics
NPI:1679024202
Name:BYRD, DARLENE (DMD,MSD,PC)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:DMD,MSD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 RIVER RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4618
Mailing Address - Country:US
Mailing Address - Phone:202-686-2108
Mailing Address - Fax:
Practice Address - Street 1:4110 RIVER RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4618
Practice Address - Country:US
Practice Address - Phone:202-686-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN46221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics