Provider Demographics
NPI:1942323167
Name:BOYLE, MIKELE LEBDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKELE
Middle Name:LEBDA
Last Name:BOYLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W LANCASTER AVE
Mailing Address - Street 2:PENN DENTAL
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3401
Mailing Address - Country:US
Mailing Address - Phone:610-520-4600
Mailing Address - Fax:610-520-4608
Practice Address - Street 1:711 W LANCASTER AVE
Practice Address - Street 2:PENN DENTAL
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3401
Practice Address - Country:US
Practice Address - Phone:610-520-4600
Practice Address - Fax:610-520-4608
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024304L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist