1972629715 NPI number — DR. DAVID M BOYD DMD

Table of content: DR. DAVID M BOYD DMD (NPI 1972629715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972629715 NPI number — DR. DAVID M BOYD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYD
Provider Other First Name:
DAVID
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972629715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGEVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63873-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-379-3650
Provider Business Mailing Address Fax Number:
573-379-5143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGEVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63873-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-379-3650
Provider Business Practice Location Address Fax Number:
573-379-5143
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  015415 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 015415 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 403349400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015415 . This is a "MO. LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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