Provider Demographics
NPI:1992845143
Name:BOYKIN, SUSAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0635
Mailing Address - Country:US
Mailing Address - Phone:919-934-3409
Mailing Address - Fax:919-934-2128
Practice Address - Street 1:101 E MARKET ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3915
Practice Address - Country:US
Practice Address - Phone:919-934-3409
Practice Address - Fax:919-934-2128
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995511Medicaid
NC95511OtherBCBS OF NC