Provider Demographics
NPI:1417158874
Name:KATHLEEN S. BOYD, DDS, PA
Entity Type:Organization
Organization Name:KATHLEEN S. BOYD, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-637-3636
Mailing Address - Street 1:640 STATESVILLE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2282
Mailing Address - Country:US
Mailing Address - Phone:704-637-3636
Mailing Address - Fax:704-637-3184
Practice Address - Street 1:640 STATESVILLE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2282
Practice Address - Country:US
Practice Address - Phone:704-637-3636
Practice Address - Fax:704-637-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4010411OtherBCBS
341264OtherBCBS TRIGON
NC8990893Medicaid
NC90893OtherBCBS
TXV06007OtherBCBS
795487OtherUNITED CONCORDIA