Provider Demographics
NPI:1912935206
Name:BYRAM, CHARLES DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:BYRAM
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 1:2676 VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1151
Mailing Address - Country:US
Mailing Address - Phone:707-422-9678
Mailing Address - Fax:
Practice Address - Street 1:3428 WATT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3613
Practice Address - Country:US
Practice Address - Phone:916-489-9990
Practice Address - Fax:916-489-9998
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice