Provider Demographics
NPI:1184891350
Name:ROBERT L. BYRUM, D.D.S.,P.C.
Entity type:Organization
Organization Name:ROBERT L. BYRUM, D.D.S.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-332-7734
Mailing Address - Street 1:3878 MIDDLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5326
Mailing Address - Country:US
Mailing Address - Phone:563-332-7734
Mailing Address - Fax:563-332-1649
Practice Address - Street 1:3878 MIDDLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5326
Practice Address - Country:US
Practice Address - Phone:563-332-7734
Practice Address - Fax:563-332-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6964261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center