Provider Demographics
NPI:1144405390
Name:BOYKIN, CARL ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ANTHONY
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SOUTH EXTENSION STREET
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083
Mailing Address - Country:US
Mailing Address - Phone:601-812-8686
Mailing Address - Fax:
Practice Address - Street 1:217 S EXTENSION ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3322
Practice Address - Country:US
Practice Address - Phone:601-812-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3431-071223G0001X
LA68241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06457826Medicaid