Provider Demographics
NPI:1366507451
Name:BOYD, MICHAEL LEE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:BOYD
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:KY
Mailing Address - Zip Code:41601-0547
Mailing Address - Country:US
Mailing Address - Phone:606-874-2800
Mailing Address - Fax:606-874-2456
Practice Address - Street 1:6363 KENTUCKY ROUTE 1428
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:KY
Practice Address - Zip Code:41601
Practice Address - Country:US
Practice Address - Phone:606-874-2800
Practice Address - Fax:606-874-2456
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry