Provider Demographics
NPI:1194860635
Name:BOYD, STANLEY J (DMD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:BOYD
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 1:77 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6840
Mailing Address - Country:US
Mailing Address - Phone:212-206-0513
Mailing Address - Fax:212-206-1232
Practice Address - Street 1:720 GREENWICH ST
Practice Address - Street 2:APT #5N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2545
Practice Address - Country:US
Practice Address - Phone:212-633-8292
Practice Address - Fax:212-206-1232
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39008OtherLICENSE