Provider Demographics
NPI:1679773535
Name:BOYD DENTAL CORPORATION
Entity type:Organization
Organization Name:BOYD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-772-0214
Mailing Address - Street 1:44100 JEFFERSON ST # D
Mailing Address - Street 2:SUITE 404
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-2712
Mailing Address - Country:US
Mailing Address - Phone:760-772-0214
Mailing Address - Fax:760-772-0583
Practice Address - Street 1:44100 JEFFERSON ST # D
Practice Address - Street 2:SUITE 404
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-2712
Practice Address - Country:US
Practice Address - Phone:760-772-0214
Practice Address - Fax:760-772-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty