Provider Demographics
NPI:1033403001
Name:BOYDEN, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BOYDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 OLYMPIC DR NW
Mailing Address - Street 2:140
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1778
Mailing Address - Country:US
Mailing Address - Phone:253-858-2406
Mailing Address - Fax:
Practice Address - Street 1:5201 OLYMPIC DR NW
Practice Address - Street 2:140
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1778
Practice Address - Country:US
Practice Address - Phone:253-858-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery