Provider Demographics
NPI:1821008426
Name:BOYDA, ROBERT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BOYDA
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 1:1910 COCHRAN RD
Mailing Address - Street 2:MANOR OAK VILLAGE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1107
Mailing Address - Country:US
Mailing Address - Phone:412-343-7855
Mailing Address - Fax:412-343-7856
Practice Address - Street 1:1910 COCHRAN RD
Practice Address - Street 2:MANOR OAK VILLAGE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1107
Practice Address - Country:US
Practice Address - Phone:412-343-7855
Practice Address - Fax:412-343-7856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030013-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU66354Medicare UPIN
PABO909050Medicare ID - Type Unspecified