Provider Demographics
NPI:1265556468
Name:BOYNTON, JAMES R (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BOYNTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 N UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-763-2331
Mailing Address - Fax:734-763-8100
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:B1B204
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0018
Practice Address - Country:US
Practice Address - Phone:734-763-2331
Practice Address - Fax:734-763-8100
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018557122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4784428Medicaid
MI4784437Medicaid
MID185570OtherBCBS OF MI DENTAL
MI1958112000OtherBCBS OF MI MED SURGICAL
OH2667592Medicaid