Healthcare Provider Details

I. General information

NPI: 1205831047
Provider Name (Legal Business Name): KENNETH WELLES BOYNTON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST STE 203
VALATIE NY
12184-9696
US

IV. Provider business mailing address

1301 RIVER ST STE 203
VALATIE NY
12184-9696
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-9291
  • Fax: 518-758-9262
Mailing address:
  • Phone: 518-758-9291
  • Fax: 518-758-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0390091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: