Provider Demographics
NPI:1750476545
Name:BYRON, JOSEPH NAZAIRE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NAZAIRE
Last Name:BYRON
Suffix:JR
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 1:100 DUKES ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2502
Mailing Address - Country:US
Mailing Address - Phone:843-563-3061
Mailing Address - Fax:843-563-7090
Practice Address - Street 1:100 DUKES ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2502
Practice Address - Country:US
Practice Address - Phone:843-563-3061
Practice Address - Fax:843-563-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ20120Medicaid