Healthcare Provider Details

I. General information

NPI: 1407318975
Provider Name (Legal Business Name): BOYU MA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE STE 206
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

801 NW 10TH ST
OKLAHOMA CITY OK
73106-6901
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7744
  • Fax:
Mailing address:
  • Phone: 860-560-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number25508
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: