Provider Demographics
NPI:1821264789
Name:BOYD, ROBERT WILLARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLARD
Last Name:BOYD
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 1:4050 WEST LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3260
Mailing Address - Country:US
Mailing Address - Phone:814-838-3715
Mailing Address - Fax:
Practice Address - Street 1:4050 WEST LAKE ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3260
Practice Address - Country:US
Practice Address - Phone:814-838-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist