Healthcare Provider Details

I. General information

NPI: 1821146960
Provider Name (Legal Business Name): KAYLA RENAE BYRNE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 FERN AVE STE 300
SHREVEPORT LA
71105-5672
US

IV. Provider business mailing address

7600 FERN AVE STE 300
SHREVEPORT LA
71105-5672
US

V. Phone/Fax

Practice location:
  • Phone: 318-524-0700
  • Fax: 318-524-0705
Mailing address:
  • Phone: 318-524-0700
  • Fax: 318-524-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: