Provider Demographics
NPI:1588150098
Name:JUNIO, BYRON JENARO MALILAY (DMD)
Entity type:Individual
Prefix:DR
First Name:BYRON JENARO
Middle Name:MALILAY
Last Name:JUNIO
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 1:725 N 25 MILE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-3053
Mailing Address - Country:US
Mailing Address - Phone:806-363-6690
Mailing Address - Fax:
Practice Address - Street 1:8129 LAKE BALLINGER WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9182
Practice Address - Country:US
Practice Address - Phone:425-361-1343
Practice Address - Fax:425-582-8205
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7305122300000X, 1223G0001X
TX35779122300000X, 1223G0001X
NMDD4947122300000X, 1223G0001X
WADE61238428122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31630871Medicaid