Healthcare Provider Details

I. General information

NPI: 1235305152
Provider Name (Legal Business Name): RICHARD L. BYRD D.D.S.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 FOREST HILL AVE SUITE 202
RICHMOND VA
23225-1844
US

IV. Provider business mailing address

9221 FOREST HILL AVE
RICHMOND VA
23235-6876
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4155
  • Fax:
Mailing address:
  • Phone: 48-330-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401007026
License Number StateVA

VIII. Authorized Official

Name: DANA CARSON
Title or Position: CONTROLLER
Credential:
Phone: 804-330-0508