Provider Demographics
NPI:1649374067
Name:BOYD, DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 OAKHURST DR B
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3714
Mailing Address - Country:US
Mailing Address - Phone:706-869-8949
Mailing Address - Fax:706-869-8948
Practice Address - Street 1:1839 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:706-736-1442
Practice Address - Fax:706-736-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice