MEDICARE: JODY H. BOYLES 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	1223G0001X	General Practice Dentistry	3465	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396848347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY H. BOYLES DDS

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-0399
Country	:	US
Telephone Number	:	304-265-0312
Fax Number	:	304-265-0314

Provider Business Practice Location Address
First Line	:	711 N PIKE ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1221
Country	:	US
Telephone Number	:	304-265-4600
Fax Number	:	304-265-6008

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/09/2007

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