Provider Demographics
NPI:1124017884
Name:BOYD, JAMES MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:BOYD
Suffix:
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 1:2813 COFFEE RD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1755
Mailing Address - Country:US
Mailing Address - Phone:209-526-4884
Mailing Address - Fax:209-526-6133
Practice Address - Street 1:2813 COFFEE RD
Practice Address - Street 2:SUITE B-2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1755
Practice Address - Country:US
Practice Address - Phone:209-526-4884
Practice Address - Fax:209-526-6133
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice