Provider Demographics
NPI:1053608901
Name:ERIC R. BOYD DDS, PC
Entity type:Organization
Organization Name:ERIC R. BOYD DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-446-6662
Mailing Address - Street 1:2516 FORUM BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5405
Mailing Address - Country:US
Mailing Address - Phone:573-446-6662
Mailing Address - Fax:573-446-6660
Practice Address - Street 1:2516 FORUM BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5405
Practice Address - Country:US
Practice Address - Phone:573-446-6662
Practice Address - Fax:573-446-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009028398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty