Provider Demographics
NPI:1982259289
Name:BOYKO, ELISABETH ANNE (RDH)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:ANNE
Last Name:BOYKO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:ELISABETH
Other - Middle Name:ANNE
Other - Last Name:BOYKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 MUIR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1848
Mailing Address - Country:US
Mailing Address - Phone:410-228-4045
Mailing Address - Fax:410-228-9384
Practice Address - Street 1:503 MUIR ST STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1848
Practice Address - Country:US
Practice Address - Phone:410-228-4045
Practice Address - Fax:410-228-9384
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7937124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid