Provider Demographics
NPI:1275728636
Name:TIMOTHY N. BYRD, D.M.D., P.C.
Entity Type:Organization
Organization Name:TIMOTHY N. BYRD, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-926-8200
Mailing Address - Street 1:2035 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5569
Mailing Address - Country:US
Mailing Address - Phone:770-926-8200
Mailing Address - Fax:770-926-8483
Practice Address - Street 1:2035 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5569
Practice Address - Country:US
Practice Address - Phone:770-926-8200
Practice Address - Fax:770-926-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty