Healthcare Provider Details

I. General information

NPI: 1821672874
Provider Name (Legal Business Name): JOSHUA E BOYD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 S WOOD DR
OKMULGEE OK
74447-6825
US

IV. Provider business mailing address

400 RIVERWALK TER STE 250
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-6500
  • Fax: 918-756-6505
Mailing address:
  • Phone: 918-998-0996
  • Fax: 918-310-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7465
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: