Provider Demographics
NPI:1942506282
Name:BONEBREAK, BYRON AUSTIN JR (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:AUSTIN
Last Name:BONEBREAK
Suffix:JR
Gender:M
Credentials:DMD MS
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Mailing Address - Street 1:12240 PLEASANT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-9647
Mailing Address - Country:US
Mailing Address - Phone:410-381-1077
Mailing Address - Fax:
Practice Address - Street 1:8191 MAPLE LAWN BLVD STE E
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2535
Practice Address - Country:US
Practice Address - Phone:410-381-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD63681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics