Provider Demographics
NPI:1396957452
Name:JOSEPH N. BYRON, JR DMD PA
Entity type:Organization
Organization Name:JOSEPH N. BYRON, JR DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-563-3061
Mailing Address - Street 1:100 DUKES STREET
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2502
Mailing Address - Country:US
Mailing Address - Phone:843-563-3061
Mailing Address - Fax:843-563-7090
Practice Address - Street 1:100 DUKES STREET
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2502
Practice Address - Country:US
Practice Address - Phone:843-563-3061
Practice Address - Fax:843-563-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ20120Medicaid