Provider Demographics
NPI:1184116402
Name:BYRD, BROOKLIN CHRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:BROOKLIN
Middle Name:CHRISTINA
Last Name:BYRD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3738
Mailing Address - Country:US
Mailing Address - Phone:901-386-3702
Mailing Address - Fax:901-380-0802
Practice Address - Street 1:6405 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3738
Practice Address - Country:US
Practice Address - Phone:901-386-3702
Practice Address - Fax:901-380-0802
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice