Provider Demographics
NPI:1982840914
Name:DANIEL R BYRNE DMD PS
Entity Type:Organization
Organization Name:DANIEL R BYRNE DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-275-6290
Mailing Address - Street 1:3110 JUDSON ST STE 179
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1254
Mailing Address - Country:US
Mailing Address - Phone:235-851-2060
Mailing Address - Fax:
Practice Address - Street 1:21 NE ROMANCE HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-275-6292
Practice Address - Fax:360-275-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6846OtherSTATE LICENSE
WA5057260Medicaid