Provider Demographics
NPI:1851621122
Name:BOYCE RANDALL LEDUKE DDS
Entity Type:Organization
Organization Name:BOYCE RANDALL LEDUKE DDS
Other - Org Name:SMILES BY LEDUKE
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-885-0497
Mailing Address - Street 1:214 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261
Mailing Address - Country:US
Mailing Address - Phone:731-885-0497
Mailing Address - Fax:731-885-0244
Practice Address - Street 1:214 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3816
Practice Address - Country:US
Practice Address - Phone:731-885-0497
Practice Address - Fax:731-885-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3604261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental