Provider Demographics
NPI:1447649900
Name:BYRON BONEBREAK DMD LLC
Entity type:Organization
Organization Name:BYRON BONEBREAK DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BONEBREAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-956-5814
Mailing Address - Street 1:100 HARBORVIEW DR
Mailing Address - Street 2:UNIT 1309
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5415
Mailing Address - Country:US
Mailing Address - Phone:443-956-5814
Mailing Address - Fax:410-779-7775
Practice Address - Street 1:100 HARBORVIEW DR
Practice Address - Street 2:UNIT 1309
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5415
Practice Address - Country:US
Practice Address - Phone:443-956-5814
Practice Address - Fax:410-779-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6368261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental