Provider Demographics
NPI:1821146960
Name:BYRNE, KAYLA RENAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:RENAE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FERN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5672
Mailing Address - Country:US
Mailing Address - Phone:318-524-0700
Mailing Address - Fax:318-524-0705
Practice Address - Street 1:7600 FERN AVE STE 300
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5672
Practice Address - Country:US
Practice Address - Phone:318-524-0700
Practice Address - Fax:318-524-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1488089OtherUNITED CONCORDIA NONNET #