Provider Demographics
NPI:1518174580
Name:BOYD, KARLA JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:JO
Last Name:BOYD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 E 76TH ST N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-272-1985
Mailing Address - Fax:
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
Practice Address - Country:US
Practice Address - Phone:918-272-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58431223G0001X
AR34941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice