Provider Demographics
NPI:1821078536
Name:BYER, FABIAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:A
Last Name:BYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FABIAN
Other - Middle Name:ANTHONY
Other - Last Name:BYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3061 BROMBLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6465
Mailing Address - Country:US
Mailing Address - Phone:404-271-5016
Mailing Address - Fax:
Practice Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:404-436-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000896332BMedicaid