Organization
BYRON DUVALL DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BYRON V DUVALL DDS (OWNER)
(314) 776-7100
Entity
Organization
Contact information
Practice address
2600 CHOUTEAU AVE, SAINT LOUIS, MO 63103-3013
(314) 776-7100
Mailing address
2600 CHOUTEAU AVE, SAINT LOUIS, MO 63103-3013
(314) 776-7100
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401339304
—
MO
Enumeration date
08/16/2012
Last updated
08/16/2012
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