Healthcare Provider Details

I. General information

NPI: 1083117253
Provider Name (Legal Business Name): KYLE AARON BOYD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-0769
US

V. Phone/Fax

Practice location:
  • Phone: 515-846-6603
  • Fax: 513-584-6661
Mailing address:
  • Phone: 513-584-6660
  • Fax: 513-584-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025699
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: