MEDICARE: DR. COURTNEY L BYRD DDS

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	8923	NC

General Provider Information

NPI Number	:	1801115134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY L BYRD DDS

Provider Business Mailing Address
First Line	:	2211 EXECUTIVE ST
Second Line	:	SUITE E
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3661
Country	:	US
Telephone Number	:	704-395-6000
Fax Number	:	704-398-7373

Provider Business Practice Location Address
First Line	:	3053B FREEDOM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3859
Country	:	US
Telephone Number	:	704-393-3911
Fax Number	:	704-392-1096

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/26/2010

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