Healthcare Provider Details

I. General information

NPI: 1144245531
Provider Name (Legal Business Name): THOMAS PATRICK BYRNES DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VA MEDICAL CENTER
BOSTON MA
02130-4817
US

IV. Provider business mailing address

396 N MAIN ST
ATTLEBORO MA
02703-1753
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone: 508-226-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16281
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: