Provider Demographics
NPI:1528017449
Name:BOYD, DARRELL ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:ROSS
Last Name:BOYD
Suffix:
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 1:500 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2734
Mailing Address - Country:US
Mailing Address - Phone:810-629-8272
Mailing Address - Fax:810-629-3218
Practice Address - Street 1:500 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2734
Practice Address - Country:US
Practice Address - Phone:810-629-8272
Practice Address - Fax:810-629-3218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010089731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice