Healthcare Provider Details

I. General information

NPI: 1639348147
Provider Name (Legal Business Name): SHARON L BYRD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR BLDG 11 STE 164
GILBERT AZ
85295-1675
US

IV. Provider business mailing address

2730 S VAL VISTA DR BLDG 11 STE 164
GILBERT AZ
85295-1675
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-9977
  • Fax:
Mailing address:
  • Phone: 480-633-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number909
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: