Provider Demographics
NPI:1497954192
Name:BOYD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BOYD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-272-0031
Mailing Address - Street 1:12899 E 76TH ST N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4026
Mailing Address - Country:US
Mailing Address - Phone:918-272-0031
Mailing Address - Fax:918-272-0041
Practice Address - Street 1:12899 E 76TH ST N
Practice Address - Street 2:SUITE 108
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4026
Practice Address - Country:US
Practice Address - Phone:918-272-0031
Practice Address - Fax:918-272-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty