Provider Demographics
NPI:1053484089
Name:LEDUKE, BOYCE RANDALL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOYCE
Middle Name:RANDALL
Last Name:LEDUKE
Suffix:JR
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:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38281-0731
Mailing Address - Country:US
Mailing Address - Phone:731-885-0497
Mailing Address - Fax:731-885-0244
Practice Address - Street 1:214 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3816
Practice Address - Country:US
Practice Address - Phone:731-885-0497
Practice Address - Fax:731-885-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDSOOOOOO36041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice