Provider Demographics
NPI:1114053121
Name:BOYETT HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BOYETT HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DO
Authorized Official - Phone:205-921-5556
Mailing Address - Street 1:2131 MILITARY ST S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-6651
Mailing Address - Country:US
Mailing Address - Phone:205-921-5556
Mailing Address - Fax:205-921-5595
Practice Address - Street 1:2131 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-6651
Practice Address - Country:US
Practice Address - Phone:205-921-5556
Practice Address - Fax:205-921-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46221223G0001X, 1223G0001X
ALDO654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1114053121OtherNPI NUMBER
AL1366480774OtherNPI
AL1306938360OtherNPI