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General NPI Number Information
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NPI Number | 1578864278
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Entity Type | Organization
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Legal Business Name | BYRON DUVALL D.D.S. GATEWAY, P.C.
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 9378 OLIVE BLVD SUITE 1LL
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City | OLIVETTE
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State | MO
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Zip | 63132-3215
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Country | US
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Telephone | 800-409-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 W. PARKSIDE LANE SUITE 201
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City | PHOENIX
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State | AZ
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Zip | 85027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BYRON DUVALL
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Credential | D.D.S.
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Telephone | 800-409-2563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 013419
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License Number State | MO
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