Provider Demographics
NPI:1952471526
Name:DUVALL, BYRON V (DDS)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:V
Last Name:DUVALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CHOUTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103
Mailing Address - Country:US
Mailing Address - Phone:314-776-7100
Mailing Address - Fax:314-776-7649
Practice Address - Street 1:2600 CHOUTEAU AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103
Practice Address - Country:US
Practice Address - Phone:314-776-7100
Practice Address - Fax:314-776-7649
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401339304Medicaid