Healthcare Provider Details

I. General information

NPI: 1528017449
Provider Name (Legal Business Name): DARRELL ROSS BOYD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N LEROY ST
FENTON MI
48430-2734
US

IV. Provider business mailing address

500 N LEROY ST
FENTON MI
48430-2734
US

V. Phone/Fax

Practice location:
  • Phone: 810-629-8272
  • Fax: 810-629-3218
Mailing address:
  • Phone: 810-629-8272
  • Fax: 810-629-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901008973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: