Provider Demographics
NPI:1780819581
Name:BOYLES, BENJAMIN BRODIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BRODIE
Last Name:BOYLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1901
Mailing Address - Country:US
Mailing Address - Phone:919-931-3234
Mailing Address - Fax:
Practice Address - Street 1:8961 HARVEST OAKS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2077
Practice Address - Country:US
Practice Address - Phone:919-676-7777
Practice Address - Fax:919-676-7947
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice