MEDICARE: DR. KEITH E BOYD, JR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	4121	AZ

General Provider Information

NPI Number	:	1275618837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH E BOYD, JR DDS

Provider Business Mailing Address
First Line	:	2006 MOUNTAIN VIEW LOOP
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86426-9299
Country	:	US
Telephone Number	:	928-768-6258
Fax Number	:	928-763-6007

Provider Business Practice Location Address
First Line	:	3003 HIGHWAY 95 STE 103
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7802
Country	:	US
Telephone Number	:	928-763-5777
Fax Number	:	928-763-6007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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