Provider Demographics
NPI:1447399795
Name:BOYKIN-MILLER, KEYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEYA
Middle Name:
Last Name:BOYKIN-MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KEYA
Other - Middle Name:
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1294 E JUDE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0297
Mailing Address - Country:US
Mailing Address - Phone:267-471-8468
Mailing Address - Fax:
Practice Address - Street 1:808 N MISSION PKWY
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-8412
Practice Address - Country:US
Practice Address - Phone:520-426-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0092251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014905350003Medicaid
PA1014905350003Medicaid