Provider Demographics
NPI:1366632705
Name:BOYD, KENNETH BERNARD SR (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BERNARD
Last Name:BOYD
Suffix:SR
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 1:838 OLD GEORGE WASHINGTON HWY N
Mailing Address - Street 2:C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2209
Mailing Address - Country:US
Mailing Address - Phone:757-558-9008
Mailing Address - Fax:757-558-9042
Practice Address - Street 1:838 OLD GEORGE WASHINGTON HWY N
Practice Address - Street 2:C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2209
Practice Address - Country:US
Practice Address - Phone:757-558-9008
Practice Address - Fax:757-558-9042
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007988122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice