Provider Demographics
NPI:1710262936
Name:BYRAM, JOSEPH RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAY
Last Name:BYRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11442 PORTAGE PL NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9785
Mailing Address - Country:US
Mailing Address - Phone:954-687-2453
Mailing Address - Fax:
Practice Address - Street 1:12165 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5124
Practice Address - Country:US
Practice Address - Phone:253-537-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81213469921122300000X
WADE60606761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist