Provider Demographics
NPI:1669590162
Name:BYERS, GORDON (DDS)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:BYERS
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 1:605 17TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5518
Mailing Address - Country:US
Mailing Address - Phone:772-562-9029
Mailing Address - Fax:772-562-9903
Practice Address - Street 1:605 17TH ST STE 2
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5518
Practice Address - Country:US
Practice Address - Phone:772-562-9029
Practice Address - Fax:772-562-9903
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN56511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice