Provider Demographics
NPI:1275743957
Name:BOYD, JAY SEVERIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SEVERIO
Last Name:BOYD
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 1:71 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3885
Mailing Address - Country:US
Mailing Address - Phone:304-725-9329
Mailing Address - Fax:
Practice Address - Street 1:1003 SUSHRUTA DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8876
Practice Address - Country:US
Practice Address - Phone:304-263-3367
Practice Address - Fax:304-263-1634
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV36681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice