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General NPI Number Information
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NPI Number | 1144405390
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Entity Type | Individual
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Provider Name | CARL ANTHONY BOYKIN DMD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 217 S EXTENSION ST
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City | HAZLEHURST
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State | MS
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Zip | 39083-3322
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Country | US
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Telephone | 601-812-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 217 SOUTH EXTENSION STREET
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City | HAZLEHURST
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State | MS
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Zip | 39083
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Country | US
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Telephone | 601-812-8686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3431-07
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6824
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License Number State | LA
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