Provider Demographics
NPI:1407900988
Name:BOYD, MASTON WADE III (DMD)
Entity Type:Individual
Prefix:DR
First Name:MASTON
Middle Name:WADE
Last Name:BOYD
Suffix:III
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 1:202 CRAYTON ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4848
Mailing Address - Country:US
Mailing Address - Phone:864-225-3111
Mailing Address - Fax:864-225-3111
Practice Address - Street 1:202 CRAYTON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4848
Practice Address - Country:US
Practice Address - Phone:864-225-3111
Practice Address - Fax:864-225-3111
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist