MEDICARE: DR. JOHN GEORGE BOYD 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	1223G0001X	General Practice Dentistry	12709	TX

General Provider Information

NPI Number	:	1548480650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GEORGE BOYD DDS

Provider Business Mailing Address
First Line	:	504 BAILEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2126
Country	:	US
Telephone Number	:	817-882-8282
Fax Number	:	817-338-1436

Provider Business Practice Location Address
First Line	:	504 BAILEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2126
Country	:	US
Telephone Number	:	817-882-8282
Fax Number	:	817-338-1436

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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