Provider Demographics
NPI:1689021255
Name:TAB A BOYLE DDS
Entity Type:Organization
Organization Name:TAB A BOYLE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-940-6350
Mailing Address - Street 1:44950 VALLEY CENTRAL WAY
Mailing Address - Street 2:STE 1-107
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44950 VALLEY CENTRAL WAY
Practice Address - Street 2:STE 1-107
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7209
Practice Address - Country:US
Practice Address - Phone:661-940-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty