Provider Demographics
NPI:1598710303
Name:BOYD, GARRY DEWAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:DEWAYNE
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 1:127 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2550
Mailing Address - Country:US
Mailing Address - Phone:740-687-4484
Mailing Address - Fax:
Practice Address - Street 1:127 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2550
Practice Address - Country:US
Practice Address - Phone:740-687-4484
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 015731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0365199Medicaid