MEDICARE: DR. BOYD WAYNE SIMKINS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	5637049	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5637049	OTHER	UT	STATE ID NUMBER
2	1692204	OTHER	UT	TRICARE PROVIDER NUMBER
3	56370499902001	OTHER	UT	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1164479267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOYD WAYNE SIMKINS D.D.S.

Provider Business Mailing Address
First Line	:	2667 N WASHINGTON BLVD
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2240
Country	:	US
Telephone Number	:	801-782-3920
Fax Number	:	801-782-4380

Provider Business Practice Location Address
First Line	:	2667 N WASHINGTON BLVD
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2240
Country	:	US
Telephone Number	:	801-782-3920
Fax Number	:	801-782-4380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/22/2023

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