Healthcare Provider Details

I. General information

NPI: 1285375915
Provider Name (Legal Business Name): RICHARD L BYRD JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NW
WASHINGTON DC
20059-2901
US

IV. Provider business mailing address

3800 SOLEBURY PL
MIDLOTHIAN VA
23113-2901
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0011
  • Fax:
Mailing address:
  • Phone: 804-335-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401417369
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12835849-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: