Provider Demographics
NPI:1457606592
Name:WILLIAM M. B. BOYD, DMD, LLC
Entity Type:Organization
Organization Name:WILLIAM M. B. BOYD, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M B
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-738-1421
Mailing Address - Street 1:1831 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5734
Mailing Address - Country:US
Mailing Address - Phone:706-738-1421
Mailing Address - Fax:706-738-1333
Practice Address - Street 1:1831 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5734
Practice Address - Country:US
Practice Address - Phone:706-738-1421
Practice Address - Fax:706-738-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014416261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental