Provider Demographics
NPI:1578669446
Name:DAVID C BOYLES JR DDS PC
Entity Type:Organization
Organization Name:DAVID C BOYLES JR DDS PC
Other - Org Name:BOYLES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS PRESIDENT OF COR
Authorized Official - Phone:281-331-1223
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:216 S JOHNSON
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511
Mailing Address - Country:US
Mailing Address - Phone:281-331-1223
Mailing Address - Fax:281-585-5586
Practice Address - Street 1:216 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2153
Practice Address - Country:US
Practice Address - Phone:281-331-1223
Practice Address - Fax:281-585-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11708122300000X
TX22656122300000X
TX5717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6243400001Medicare NSC