Provider Demographics
NPI:1760721419
Name:TIMOTHY N BYRD, DMD AND ASSOC, PC
Entity Type:Organization
Organization Name:TIMOTHY N BYRD, DMD AND ASSOC, PC
Other - Org Name:GRELOT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-808-2541
Mailing Address - Street 1:5920B GRELOT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3604
Mailing Address - Country:US
Mailing Address - Phone:251-343-5974
Mailing Address - Fax:251-343-0431
Practice Address - Street 1:5920B GRELOT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3604
Practice Address - Country:US
Practice Address - Phone:251-343-5974
Practice Address - Fax:251-343-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty