1417158874 NPI number — KATHLEEN S. BOYD, DDS, PA

Table of content: (NPI 1417158874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417158874 NPI number — KATHLEEN S. BOYD, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN S. BOYD, DDS, PA
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:
1417158874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 STATESVILLE BLVD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28144-2282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-637-3636
Provider Business Mailing Address Fax Number:
704-637-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 STATESVILLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-637-3636
Provider Business Practice Location Address Fax Number:
704-637-3184
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ENDODONTIST
Authorized Official Telephone Number:
704-637-3636

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  6007 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4010411 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 341264 . This is a "BCBS TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8990893 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90893 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: V06007 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 795487 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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