Provider Demographics
NPI:1689054801
Name:BOYLES-HORAN, MACKENZIE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ELIZABETH
Last Name:BOYLES-HORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 MORGANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4505
Mailing Address - Country:US
Mailing Address - Phone:304-777-4113
Mailing Address - Fax:
Practice Address - Street 1:1315 MORGANTOWN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4505
Practice Address - Country:US
Practice Address - Phone:304-777-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist