Healthcare Provider Details

I. General information

NPI: 1174895056
Provider Name (Legal Business Name): DONALD W BOYLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 S BASCOM AVE
SAN JOSE CA
95124-2663
US

IV. Provider business mailing address

3996 S BASCOM AVE
SAN JOSE CA
95124-2663
US

V. Phone/Fax

Practice location:
  • Phone: 408-377-6286
  • Fax: 408-377-8183
Mailing address:
  • Phone: 408-377-6286
  • Fax: 408-377-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: