Provider Demographics
NPI:1467295840
Name:BYRD, TANNOR ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:TANNOR
Middle Name:ALLEN
Last Name:BYRD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LANHAM RD
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-3810
Mailing Address - Country:US
Mailing Address - Phone:803-634-9892
Mailing Address - Fax:
Practice Address - Street 1:901 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4323
Practice Address - Country:US
Practice Address - Phone:803-637-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.108261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice