Provider Demographics
NPI:1760481857
Name:BOYD, MARVIN AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:AUSTIN
Last Name:BOYD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 OLD SPRINGVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-7607
Mailing Address - Country:US
Mailing Address - Phone:205-854-8535
Mailing Address - Fax:205-854-9394
Practice Address - Street 1:5239 OLD SPRINGVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-7607
Practice Address - Country:US
Practice Address - Phone:205-854-8535
Practice Address - Fax:205-854-9394
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AL47651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL76311OtherBCBS PROVIDER ID
AL975541OtherUNITED CONCORDIA PROVIDER