Basic Information
Provider Information | |||||||||
NPI: | 1053322271 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BYRNE | ||||||||
FirstName: | STEPHEN | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | RR#1 BOX #1060 | ||||||||
Address2: |   | ||||||||
City: | CUSHING | ||||||||
State: | OK | ||||||||
PostalCode: | 740230000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9182250104 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | ALLEN DENTAL CLINIC | ||||||||
Address2: | 6037 BESSINGER RD | ||||||||
City: | FORT SILL | ||||||||
State: | OK | ||||||||
PostalCode: | 735030000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5804426106 | ||||||||
FaxNumber: | 5804427150 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | OK3659 | OK | Y |   | Dental Providers | Dentist | General Practice |
No ID Information.