Provider Demographics
NPI:1912272295
Name:BYRD DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:BYRD DENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-379-1550
Mailing Address - Street 1:7115 GUILFORD DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5199
Mailing Address - Country:US
Mailing Address - Phone:240-379-1550
Mailing Address - Fax:301-662-6879
Practice Address - Street 1:7115 GUILFORD DR
Practice Address - Street 2:STE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5199
Practice Address - Country:US
Practice Address - Phone:240-379-1550
Practice Address - Fax:301-662-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD58931223G0001X
MD45081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty