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NPI Code Detail

MEDICARE: DR. RUSSELL LANE BOYD DMD, PC

MEDICARE:  DR. RUSSELL LANE BOYD  DMD, PC
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
11223G0001XGeneral Practice Dentistry11407GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1582663987OTHERGATAX ID

General Provider Information

NPI Number : 1669518742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL LANE BOYD DMD, PC
Provider Business Mailing Address
First Line : 7000 PEACHTREE DUNWOODY RD NE
Second Line : BUILDING 2, SUITE 100
City : ATLANTA
State : GA
Zip : 30328-1655
Country : US
Telephone Number : 770-351-9222
Fax Number : 770-351-0463
Provider Business Practice Location Address
First Line : 7000 PEACHTREE DUNWOODY RD
Second Line : BUILDING 2, SUITE 100
City : ATLANTA
State : GA
Zip : 30328-1655
Country : US
Telephone Number : 770-351-9222
Fax Number : 770-351-0463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 02/12/2015

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Directions to “ DR. RUSSELL LANE BOYD DMD, PC” Practice Location

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