Provider Demographics
NPI:1659570869
Name:KENNETH C BOYLE DMD PC
Entity Type:Organization
Organization Name:KENNETH C BOYLE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-459-2263
Mailing Address - Street 1:111 EAST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202
Mailing Address - Country:US
Mailing Address - Phone:570-459-2263
Mailing Address - Fax:570-459-5922
Practice Address - Street 1:111 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-459-2263
Practice Address - Fax:570-459-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026322L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty