Provider Demographics
NPI:1285814772
Name:BOYER, JARUM MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARUM
Middle Name:MICHAEL
Last Name:BOYER
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 1:351 W 6TH ST
Mailing Address - Street 2:SUITE 19 BLDG 440 US ARMY DENTAL ACTIVITY
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-4707
Mailing Address - Country:US
Mailing Address - Phone:912-767-6735
Mailing Address - Fax:912-767-5425
Practice Address - Street 1:351 W 6TH ST
Practice Address - Street 2:SUITE 19 BLDG 440 US ARMY DENTAL ACTIVITY
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-4707
Practice Address - Country:US
Practice Address - Phone:912-767-6735
Practice Address - Fax:912-767-5425
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65942819921122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice