Provider Demographics
NPI:1346314317
Name:BOYD, SUSAN LEE (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:BOYD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND
Mailing Address - Street 2:SUITE 426
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-497-5252
Mailing Address - Fax:281-497-1303
Practice Address - Street 1:12121 RICHMOND
Practice Address - Street 2:SUITE 426
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-497-5252
Practice Address - Fax:281-497-1303
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice