1992845143 NPI number — DR. SUSAN M. BOYKIN D.D.S.

Table of content: DR. SUSAN M. BOYKIN D.D.S. (NPI 1992845143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992845143 NPI number — DR. SUSAN M. BOYKIN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKIN
Provider First Name:
SUSAN
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

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:
1992845143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27577-0635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-934-3409
Provider Business Mailing Address Fax Number:
919-934-2128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-934-3409
Provider Business Practice Location Address Fax Number:
919-934-2128
Provider Enumeration Date:
02/07/2007

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: 1223G0001X , with the licence number:  6401 , 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: 8995511 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95511 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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