Healthcare Provider Details

I. General information

NPI: 1740258227
Provider Name (Legal Business Name): ROBIN ROBERT BOYD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 2ND ST
WINSLOW AZ
86047-3406
US

IV. Provider business mailing address

321 W 2ND ST
WINSLOW AZ
86047-3406
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4441
  • Fax: 928-289-8722
Mailing address:
  • Phone: 928-289-4441
  • Fax: 928-289-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD3500
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: