Provider Demographics
NPI:1861416968
Name:BOYD, JOHN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
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:PO BOX 367
Mailing Address - Street 2:268 HWY 62
Mailing Address - City:BARDWELL
Mailing Address - State:KY
Mailing Address - Zip Code:42023-0367
Mailing Address - Country:US
Mailing Address - Phone:270-628-3512
Mailing Address - Fax:270-628-3513
Practice Address - Street 1:268 HWY 62
Practice Address - Street 2:
Practice Address - City:BARDWELL
Practice Address - State:KY
Practice Address - Zip Code:42023-0367
Practice Address - Country:US
Practice Address - Phone:270-628-3512
Practice Address - Fax:270-628-3513
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053832Medicare ID - Type UnspecifiedKY MEDICARE