Provider Demographics
NPI:1285642249
Name:BROYLES, DEBORAH BOYKIN (DMD)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:BOYKIN
Last Name:BROYLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BEAMAN STREET SUITE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2695
Mailing Address - Country:US
Mailing Address - Phone:910-592-3613
Mailing Address - Fax:910-592-7808
Practice Address - Street 1:603 BEAMAN STREET SUITE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2695
Practice Address - Country:US
Practice Address - Phone:910-592-3613
Practice Address - Fax:910-592-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5698122300000X
SC2912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist