Provider Demographics
NPI:1316285034
Name:BYRD, TIMOTHY N (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
Last Name:BYRD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 WHITESTONE PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3715
Mailing Address - Country:US
Mailing Address - Phone:404-846-2132
Mailing Address - Fax:404-869-9955
Practice Address - Street 1:5920B GRELOT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3604
Practice Address - Country:US
Practice Address - Phone:251-343-5974
Practice Address - Fax:251-343-0431
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist