=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215198858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY LOGAN BOYD D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2008
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 914 BAY RIDGE RD SUITE 205
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21403-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-626-1797
-----------------------------------------------------
Fax | 410-626-9809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 914 BAY RIDGE RD SUITE 205
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21403-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-626-1797
-----------------------------------------------------
Fax | 410-626-9809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8580
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------