Provider Demographics
NPI:1881139848
Name:BRIAN P BOYD DDS,PLC
Entity type:Organization
Organization Name:BRIAN P BOYD DDS,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-982-5334
Mailing Address - Street 1:2425 MILITARY ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-982-5334
Mailing Address - Fax:810-982-1306
Practice Address - Street 1:2425 MILITARY ST
Practice Address - Street 2:BLDG. 4
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-982-5334
Practice Address - Fax:810-982-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty