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General NPI Number Information
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NPI Number | 1447785571
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Entity Type | Individual
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Provider Name | IKETRIA BYRD D.D.S
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 5201 VETERANS MEMORIAL BLVD UNIT A
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City | METAIRIE
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State | LA
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Zip | 70006-5122
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Country | US
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Telephone | 504-273-7156
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6003
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City | MONROE
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State | LA
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Zip | 71211-6003
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Country | US
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Telephone | 318-537-4492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 32797
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 25769
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-0006885-C1
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7471
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License Number State | LA
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