1053583336 NPI number — JAMES H BOYD JR DDS LTD

Table of content: (NPI 1053583336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053583336 NPI number — JAMES H BOYD JR DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES H BOYD JR DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053583336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
549 E BRAMBLETON AVENUE
Provider Second Line Business Mailing Address:
STE 9
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-623-4820
Provider Business Mailing Address Fax Number:
757-623-2078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 E BRAMBLETON AVENUE
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-623-4820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
757-623-4820

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4060 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 606011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006108 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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