Healthcare Provider Details

I. General information

NPI: 1598802373
Provider Name (Legal Business Name): WILLIAM G BYRNE DDS MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR STE 8
RIVERSIDE CA
92503
US

IV. Provider business mailing address

3838 SHERMAN DR STE 8
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-6040
  • Fax: 951-687-4216
Mailing address:
  • Phone: 951-687-6040
  • Fax: 951-687-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21975
License Number StateCA

VIII. Authorized Official

Name: MRS. ANITA LOUISE BACON
Title or Position: RECEPTIONIST - INS BILLER
Credential:
Phone: 951-687-6040