Provider Demographics
NPI:1134525041
Name:STEPHEN R. BYRD, D.D.S.,P.C.
Entity type:Organization
Organization Name:STEPHEN R. BYRD, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-627-3283
Mailing Address - Street 1:2755 PINE ST
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31091-7703
Mailing Address - Country:US
Mailing Address - Phone:478-627-3283
Mailing Address - Fax:478-627-9010
Practice Address - Street 1:2755 PINE ST
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091-7703
Practice Address - Country:US
Practice Address - Phone:478-627-3283
Practice Address - Fax:478-627-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009024261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental