Provider Demographics
NPI:1205935970
Name:BOYNTON FAMILY DENTAL ARTS
Entity type:Organization
Organization Name:BOYNTON FAMILY DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-685-8881
Mailing Address - Street 1:1901 N WEBB RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3415
Mailing Address - Country:US
Mailing Address - Phone:316-685-8881
Mailing Address - Fax:316-634-8323
Practice Address - Street 1:1901 N WEBB RD
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3415
Practice Address - Country:US
Practice Address - Phone:316-685-8881
Practice Address - Fax:316-634-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
420711OtherBLUE CROSS
000725367OtherUNITED CONCORDIA