Healthcare Provider Details

I. General information

NPI: 1972987287
Provider Name (Legal Business Name): BYRON C DESBORDES, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 LORD BALTIMORE DR STE 100
BALTIMORE MD
21244-2663
US

IV. Provider business mailing address

3120 LORD BALTIMORE DR STE 100
BALTIMORE MD
21244-2663
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-0138
  • Fax: 410-277-0139
Mailing address:
  • Phone: 410-277-0138
  • Fax: 410-277-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BYRON C DESBORDES
Title or Position: OWNER
Credential: DDS
Phone: 410-277-0138