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General NPI Number Information
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NPI Number | 1477888949
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Entity Type | Organization
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Legal Business Name | BYRON DENTAL GROUP PA
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 21 NE FRONTAGE RD.
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City | BYRON
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State | MN
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Zip | 55920
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Country | US
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Telephone | 507-775-6445
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Fax | 507-775-6446
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Provider Business Mailing Address
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Address Line | P.O. BOX 37 21 NE FRONTAGE RD.,
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City | BYRON
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State | MN
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Zip | 55920
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Country | US
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Telephone | 507-775-6445
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Fax | 507-775-6446
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI LEE STACKHOUSE
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Credential |
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Telephone | 507-775-6445
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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 |
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License Number State |
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