Healthcare Provider Details

I. General information

NPI: 1134643000
Provider Name (Legal Business Name): ZACHARY BYRNE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 S. HWY 53
LAGRANGE KY
40031
US

IV. Provider business mailing address

3108 S HIGHWAY 53
LA GRANGE KY
40031-9533
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-1494
  • Fax:
Mailing address:
  • Phone: 502-222-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9996
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: