Healthcare Provider Details

I. General information

NPI: 1710081716
Provider Name (Legal Business Name): GERARD BYRNE DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH AND HOLDREGE STREETS UNIVERSITY OF NEBRASKA MEDICAL CENTER, COLLEGE OF DENTI
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

40TH AND HOLDREGE STREETS POBOX 830740
LINCOLN NE
68583-0740
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1631
  • Fax:
Mailing address:
  • Phone: 402-472-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number40084
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number114
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: