Provider Demographics
NPI:1275690539
Name:BOYKO, MICHAEL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PETER
Last Name:BOYKO
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:PO BOX 6649
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92412-6649
Mailing Address - Country:US
Mailing Address - Phone:951-359-4911
Mailing Address - Fax:951-351-2013
Practice Address - Street 1:4942 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2708
Practice Address - Country:US
Practice Address - Phone:951-359-4911
Practice Address - Fax:951-351-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice