=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417158874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN S. BOYD, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 STATESVILLE BLVD SUITE 3
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-637-3636
-----------------------------------------------------
Fax | 704-637-3184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 640 STATESVILLE BLVD SUITE 3
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-637-3636
-----------------------------------------------------
Fax | 704-637-3184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ENDODONTIST
-----------------------------------------------------
Name | DR. KATHLEEN S BOYD
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 704-637-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 6007
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------