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General NPI Number Information
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NPI Number | 1053608901
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Entity Type | Organization
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Legal Business Name | ERIC R. BOYD DDS, PC
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 2516 FORUM BLVD SUITE #200
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City | COLUMBIA
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State | MO
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Zip | 65203-5405
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Country | US
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Telephone | 573-446-6662
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Fax | 573-446-6660
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Provider Business Mailing Address
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Address Line | 2516 FORUM BLVD SUITE #200
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City | COLUMBIA
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State | MO
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Zip | 65203-5405
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Country | US
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Telephone | 573-446-6662
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Fax | 573-446-6660
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC ROGER BOYD
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Credential | DDS
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Telephone | 573-446-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2009028398
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License Number State | MO
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