Provider Demographics
NPI:1255532354
Name:BOYD, TIFFANY DAWN (DMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:DAWN
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 1:3720 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5510
Mailing Address - Country:US
Mailing Address - Phone:941-758-6684
Mailing Address - Fax:941-758-0298
Practice Address - Street 1:3720 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5510
Practice Address - Country:US
Practice Address - Phone:941-758-6684
Practice Address - Fax:941-758-0298
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 148301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice