Provider Demographics
NPI:1295914364
Name:TIMOTHY N. BYRD, DMD & ASSOCIATES OF DOUGLASVILLE, PC
Entity type:Organization
Organization Name:TIMOTHY N. BYRD, DMD & ASSOCIATES OF DOUGLASVILLE, PC
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:770-949-5600
Mailing Address - Street 1:6040 DOUGLAS BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135
Mailing Address - Country:US
Mailing Address - Phone:770-949-5600
Mailing Address - Fax:770-949-5055
Practice Address - Street 1:6040 DOUGLAS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:770-949-5600
Practice Address - Fax:770-949-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty