Provider Demographics
NPI:1477695591
Name:BOYER, GREGORY MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:BOYER
Suffix:
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 1:2667 FARRAGUT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1462
Mailing Address - Country:US
Mailing Address - Phone:217-546-8811
Mailing Address - Fax:217-546-8814
Practice Address - Street 1:2667 FARRAGUT DR
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1462
Practice Address - Country:US
Practice Address - Phone:217-546-8811
Practice Address - Fax:217-546-8814
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist