Provider Demographics
NPI:1841304292
Name:BOYD, CHARLES BRENT (DDS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BRENT
Last Name:BOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5008 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1416
Mailing Address - Country:US
Mailing Address - Phone:254-771-2515
Mailing Address - Fax:254-771-1955
Practice Address - Street 1:5008 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1416
Practice Address - Country:US
Practice Address - Phone:254-771-2515
Practice Address - Fax:254-771-1955
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBB2932019OtherPRESCRIPTION DEA REG #