Healthcare Provider Details

I. General information

NPI: 1598853442
Provider Name (Legal Business Name): MICHAEL JEROME BOYKIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S SDB 58
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

108 WAGON WHEEL CIR
ALABASTER AL
35007-5826
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2340
  • Fax: 205-934-7899
Mailing address:
  • Phone: 205-620-9662
  • Fax: 205-975-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberAL 4492
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: