Provider Demographics
NPI:1740311224
Name:BYERS, STEPHEN WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WALTER
Last Name:BYERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:126 SOUTH CODY ROAD
Mailing Address - City:LECLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-0606
Mailing Address - Country:US
Mailing Address - Phone:563-289-3249
Mailing Address - Fax:
Practice Address - Street 1:126 SOUTH CODY ROAD
Practice Address - Street 2:
Practice Address - City:LECLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-0606
Practice Address - Country:US
Practice Address - Phone:563-289-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0191163Medicaid