Provider Demographics
NPI:1801886452
Name:BOYD, CHASE T (DDS)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:T
Last Name:BOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5109
Mailing Address - Country:US
Mailing Address - Phone:931-648-0191
Mailing Address - Fax:931-648-4235
Practice Address - Street 1:1877 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5109
Practice Address - Country:US
Practice Address - Phone:931-648-0191
Practice Address - Fax:931-648-4235
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice