Provider Demographics
NPI:1952564841
Name:KEITH E. BOYD JR DDS PC
Entity Type:Organization
Organization Name:KEITH E. BOYD JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-763-5777
Mailing Address - Street 1:3003 HIGHWAY 95
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7860
Mailing Address - Country:US
Mailing Address - Phone:928-763-5777
Mailing Address - Fax:928-763-6007
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE 103
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7860
Practice Address - Country:US
Practice Address - Phone:928-763-5777
Practice Address - Fax:928-763-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty