Healthcare Provider Details

I. General information

NPI: 1093988792
Provider Name (Legal Business Name): HUBERT H BYRON, DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S WALKER ST
PRINCETON WV
24740-2747
US

IV. Provider business mailing address

202 S WALKER ST
PRINCETON WV
24740-2747
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-2026
  • Fax:
Mailing address:
  • Phone: 304-425-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2517
License Number StateWV

VIII. Authorized Official

Name: DR. HUBERT H BYRON
Title or Position: PRESIDENT
Credential: DMD
Phone: 304-425-3834