MEDICARE: BYRON DUVALL DDS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0221X	Pediatric Dentistry
3	1223P0300X	Periodontics
4	1223P0700X	Prosthodontics
5	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346598661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BYRON DUVALL DDS LLC

Provider Business Mailing Address
First Line	:	2600 CHOUTEAU AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-3013
Country	:	US
Telephone Number	:	314-776-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 CHOUTEAU AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-3013
Country	:	US
Telephone Number	:	314-776-7100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BYRON V DUVALL
Credential	:	DDS
Telephone Number	:	314-776-7100

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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