1891027553 NPI number — DR. KATHERINE BYERLY DDS

Table of content: DR. KATHERINE BYERLY DDS (NPI 1891027553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891027553 NPI number — DR. KATHERINE BYERLY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYERLY
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891027553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MONUMENT CIRCLE
Provider Second Line Business Mailing Address:
SUITE 3350
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-632-1488
Provider Business Mailing Address Fax Number:
317-686-1692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MONUMENT CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 3350
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-632-1488
Provider Business Practice Location Address Fax Number:
317-686-1692
Provider Enumeration Date:
02/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6381 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 12012204 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com