Healthcare Provider Details

I. General information

NPI: 1841525722
Provider Name (Legal Business Name): BRIDGET ELLEN BYRNE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST DEAN'S OFFICE ROOM 450
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

520 NORTH 12 STREET ROOM 450 DEAN'S OFFICE
RICHMOND VA
23298-0566
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9184
  • Fax: 804-828-6072
Mailing address:
  • Phone: 804-828-9184
  • Fax: 804-828-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401006210
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: