Provider Demographics
NPI:1194189878
Name:BOYD, THANA DAWN (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:THANA
Middle Name:DAWN
Last Name:BOYD
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:THANA
Other - Middle Name:DAWN
Other - Last Name:TACHEENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTAL HYGIENIST
Mailing Address - Street 1:4041 N CENTRAL AVE
Mailing Address - Street 2:BLDG. C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3330
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:602-263-0452
Practice Address - Street 1:4041 N CENTRAL AVE
Practice Address - Street 2:BLDG. C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3330
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:602-263-0452
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000871223D0004X
AZH06758124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No1223D0004XDental ProvidersDentistDentist Anesthesiologist