Healthcare Provider Details

I. General information

NPI: 1023005733
Provider Name (Legal Business Name): JANA ELAINE BOYD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 S HARRELLS FERRY RD
BATON ROUGE LA
70816-2368
US

IV. Provider business mailing address

2509 BERRYBROOK DR
BATON ROUGE LA
70816-2886
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-5920
  • Fax:
Mailing address:
  • Phone: 757-284-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5337
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: