Provider Demographics
NPI:1720496144
Name:BOYKIN, DESHAYDIA (DMD)
Entity Type:Individual
Prefix:
First Name:DESHAYDIA
Middle Name:
Last Name:BOYKIN
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 1:25 KNIGHT BOXX RD APT 8204
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5149 NORMANDY BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4861
Practice Address - Country:US
Practice Address - Phone:904-781-1201
Practice Address - Fax:904-781-4625
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 208211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice