Provider Demographics
NPI:1063628196
Name:J DAVID BOYD DDS PA
Entity Type:Organization
Organization Name:J DAVID BOYD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:704-636-1533
Mailing Address - Street 1:644 STATESVILLE BLVD
Mailing Address - Street 2:STE #4
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2281
Mailing Address - Country:US
Mailing Address - Phone:704-636-1533
Mailing Address - Fax:704-636-5514
Practice Address - Street 1:644 STATESVILLE BLVD
Practice Address - Street 2:STE #4
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2281
Practice Address - Country:US
Practice Address - Phone:704-636-1533
Practice Address - Fax:704-636-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990917Medicaid
TN4077018OtherBCBS
VA175565OtherBCBS ANTHEM
NC90917OtherMCHC BCBS
544878OtherUNITED CONCORDIA
TN4077018OtherBCBS