Provider Demographics
NPI:1669587812
Name:BOYDSTON, HARRY L (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:L
Last Name:BOYDSTON
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 1:4601 W 109TH ST
Mailing Address - Street 2:#322
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-491-3395
Mailing Address - Fax:913-491-1008
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:#322
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-491-3395
Practice Address - Fax:913-491-1008
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist