MEDICARE: KIMBERLY BETH BOYLE DDS

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	122300000X	Dentist	0401008705	VA

General Provider Information

NPI Number	:	1225475767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BETH BOYLE DDS

Provider Business Mailing Address
First Line	:	8044 GOODLIFE CT
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-7539
Country	:	US
Telephone Number	:	804-241-7108
Fax Number	:

Provider Business Practice Location Address
First Line	:	6366 MECHANICSVILLE TPKE
Second Line	:	SUITE 205
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-4704
Country	:	US
Telephone Number	:	804-569-0530
Fax Number	:	804-569-9531

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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