Provider Demographics
NPI:1154463339
Name:WELTON, BOYD DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:DAVID
Last Name:WELTON
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 1:1277 W 12600 S STE 304
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7096
Mailing Address - Country:US
Mailing Address - Phone:801-446-1110
Mailing Address - Fax:801-446-1529
Practice Address - Street 1:1277 W 12600 S STE 304
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7096
Practice Address - Country:US
Practice Address - Phone:801-446-1110
Practice Address - Fax:801-446-1529
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT326168-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics