Provider Demographics
NPI:1629389879
Name:BOYAN, TRACY L (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:BOYAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 VENTANA DEL ROBLES
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5016
Mailing Address - Country:US
Mailing Address - Phone:805-610-7281
Mailing Address - Fax:
Practice Address - Street 1:680 VENTANA DEL ROBLES
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5016
Practice Address - Country:US
Practice Address - Phone:805-610-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist