Provider Demographics
NPI:1831386432
Name:BOYD, BRIAN PATRICK (DDS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
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 1:2425 MILITARY ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-982-5334
Mailing Address - Fax:810-982-1306
Practice Address - Street 1:2425 MILITARY ST
Practice Address - Street 2:BLDG 4
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6692
Practice Address - Country:US
Practice Address - Phone:810-982-5334
Practice Address - Fax:810-982-1306
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist