Provider Demographics
NPI:1063458099
Name:DESBORDES, BYRON CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:CHARLES
Last Name:DESBORDES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 LORD BALTIMORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2662
Mailing Address - Country:US
Mailing Address - Phone:410-277-0138
Mailing Address - Fax:410-277-0139
Practice Address - Street 1:3120 LORD BALTIMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2662
Practice Address - Country:US
Practice Address - Phone:410-277-0138
Practice Address - Fax:410-277-0139
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice