Provider Demographics
NPI:1801278601
Name:MALCOLM J BOYKIN DDS INC
Entity type:Organization
Organization Name:MALCOLM J BOYKIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-789-2330
Mailing Address - Street 1:2005 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2504
Mailing Address - Country:US
Mailing Address - Phone:760-789-2330
Mailing Address - Fax:760-789-2135
Practice Address - Street 1:2005 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2504
Practice Address - Country:US
Practice Address - Phone:760-789-2330
Practice Address - Fax:760-789-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty