Provider Demographics
NPI:1871657833
Name:ROME, BYRON R (DDS, APDC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:R
Last Name:ROME
Suffix:
Gender:M
Credentials:DDS, APDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3444
Mailing Address - Country:US
Mailing Address - Phone:225-621-2700
Mailing Address - Fax:225-644-0493
Practice Address - Street 1:306 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3444
Practice Address - Country:US
Practice Address - Phone:225-621-2700
Practice Address - Fax:225-644-0493
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist