Provider Demographics
NPI:1548480650
Name:BOYD, JOHN GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:BOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2126
Mailing Address - Country:US
Mailing Address - Phone:817-882-8282
Mailing Address - Fax:817-338-1436
Practice Address - Street 1:504 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2126
Practice Address - Country:US
Practice Address - Phone:817-882-8282
Practice Address - Fax:817-338-1436
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice