Provider Demographics
NPI:1467470856
Name:BOYD, BRADFORD MOORE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:MOORE
Last Name:BOYD
Suffix:JR
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 1:151 E AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3520
Mailing Address - Country:US
Mailing Address - Phone:661-842-1179
Mailing Address - Fax:661-942-7157
Practice Address - Street 1:151 E AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3520
Practice Address - Country:US
Practice Address - Phone:661-842-1179
Practice Address - Fax:661-942-7157
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice