Provider Demographics
NPI:1780628206
Name:BOYLE, JIM (DMD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:BOYLE
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 1:4246 MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2605
Mailing Address - Country:US
Mailing Address - Phone:770-943-6191
Mailing Address - Fax:770-943-7090
Practice Address - Street 1:4246 MARIETTA ST
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2605
Practice Address - Country:US
Practice Address - Phone:770-943-6191
Practice Address - Fax:770-943-7090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice