Healthcare Provider Details

I. General information

NPI: 1750476545
Provider Name (Legal Business Name): JOSEPH NAZAIRE BYRON JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DUKES ST
SAINT GEORGE SC
29477-2502
US

IV. Provider business mailing address

100 DUKES ST
SAINT GEORGE SC
29477-2502
US

V. Phone/Fax

Practice location:
  • Phone: 843-563-3061
  • Fax: 843-563-7090
Mailing address:
  • Phone: 843-563-3061
  • Fax: 843-563-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2012
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: