Provider Demographics
NPI:1164476446
Name:BOYKIN, MALCOLM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:BOYKIN
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:CMR 442
Mailing Address - Street 2:HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO,AE
Mailing Address - State:NY
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:062-211-7272
Mailing Address - Fax:
Practice Address - Street 1:CMR 442
Practice Address - Street 2:HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO,AE
Practice Address - State:NY
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:062-211-7272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist