Provider Demographics
NPI:1013323880
Name:BOYD, ASHLEY TATE (DMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TATE
Last Name:BOYD
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 1:1400 HIGHWAY 78 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHWAY 78 W
Practice Address - Street 2:SUITE 300
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3687
Practice Address - Country:US
Practice Address - Phone:205-384-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist