Provider Demographics
NPI:1952552127
Name:EVERETT E BYROM, JR., DDS, PC
Entity Type:Organization
Organization Name:EVERETT E BYROM, JR., DDS, PC
Other - Org Name:POTET DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-276-3351
Mailing Address - Street 1:821 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:POTEET
Mailing Address - State:TX
Mailing Address - Zip Code:78065-4247
Mailing Address - Country:US
Mailing Address - Phone:830-276-3351
Mailing Address - Fax:830-742-4006
Practice Address - Street 1:821 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:POTEET
Practice Address - State:TX
Practice Address - Zip Code:78065-4247
Practice Address - Country:US
Practice Address - Phone:830-276-3351
Practice Address - Fax:830-742-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty