Provider Demographics
NPI:1023677754
Name:DAVID M BOYD DAVID M BOYD DMD
Entity type:Organization
Organization Name:DAVID M BOYD DAVID M BOYD DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:573-379-3650
Mailing Address - Street 1:118 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873-1612
Mailing Address - Country:US
Mailing Address - Phone:573-379-3650
Mailing Address - Fax:
Practice Address - Street 1:118 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63873-1612
Practice Address - Country:US
Practice Address - Phone:573-379-3650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID M BOYD DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies