Provider Demographics
NPI:1003266057
Name:BANDY, BOYD (DMD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:
Last Name:BANDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 N WILLOWBROOK
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3201
Mailing Address - Country:US
Mailing Address - Phone:307-630-9755
Mailing Address - Fax:
Practice Address - Street 1:55 N 400 E
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-7710
Practice Address - Country:US
Practice Address - Phone:307-630-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9829784-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist