Provider Demographics
NPI:1518350305
Name:BENJAMIN BOYLES DDS PA
Entity Type:Organization
Organization Name:BENJAMIN BOYLES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-847-0150
Mailing Address - Street 1:700 EXPOSITION PL
Mailing Address - Street 2:SUITE #191
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1560
Mailing Address - Country:US
Mailing Address - Phone:919-847-0150
Mailing Address - Fax:919-847-7384
Practice Address - Street 1:700 EXPOSITION PL
Practice Address - Street 2:SUITE #191
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1560
Practice Address - Country:US
Practice Address - Phone:919-847-0150
Practice Address - Fax:919-847-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8758122300000X
NC3649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty