Healthcare Provider Details

I. General information

NPI: 1972629715
Provider Name (Legal Business Name): DAVID M BOYD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. DAVID M BOYD

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E MAIN ST
PORTAGEVILLE MO
63873-1612
US

IV. Provider business mailing address

118 E MAIN ST
PORTAGEVILLE MO
63873-1612
US

V. Phone/Fax

Practice location:
  • Phone: 573-379-3650
  • Fax: 573-379-5143
Mailing address:
  • Phone: 573-379-3650
  • Fax: 573-379-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number015415
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015415
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: