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General NPI Number Information
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NPI Number | 1295914364
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Entity Type | Organization
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Legal Business Name | TIMOTHY N. BYRD, DMD & ASSOCIATES OF DOUGLASVILLE, PC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 6040 DOUGLAS BLVD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 770-949-5600
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Fax | 770-949-5055
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Provider Business Mailing Address
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Address Line | 6040 DOUGLAS BOULEVARD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 770-949-5600
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Fax | 770-949-5055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY N. BYRD
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Credential | D.M.D.
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Telephone | 770-949-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 012070
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License Number State | GA
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