Provider Demographics
NPI:1639376148
Name:GLENN A. BOYLES, DDS, MS, PLLC
Entity Type:Organization
Organization Name:GLENN A. BOYLES, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-363-8530
Mailing Address - Street 1:301 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4034
Mailing Address - Country:US
Mailing Address - Phone:304-363-8530
Mailing Address - Fax:304-363-8522
Practice Address - Street 1:301 MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4034
Practice Address - Country:US
Practice Address - Phone:304-363-8530
Practice Address - Fax:304-363-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV30081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty