=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598710303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARRY DEWAYNE BOYD D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 W 6TH AVE
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-687-4484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 W 6TH AVE
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-687-4484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30 015731
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------