MEDICARE: DR. ELZIE LEE BYRD LL D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30 .015406	OH

General Provider Information

NPI Number	:	1043427123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELZIE LEE BYRD LL D.D.S

Provider Business Mailing Address
First Line	:	1557 WOOSTER AVE
Second Line	:	#102
City	:	AKRON
State	:	OH
Zip	:	44320-4061
Country	:	US
Telephone Number	:	330-873-1622
Fax Number	:	330-836-3933

Provider Business Practice Location Address
First Line	:	1557 WOOSTER AVE
Second Line	:	#102
City	:	AKRON
State	:	OH
Zip	:	44320-4061
Country	:	US
Telephone Number	:	330-873-1622
Fax Number	:	330-836-3933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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