Provider Demographics
NPI:1013444348
Name:BOYD, TERA (DDS)
Entity type:Individual
Prefix:DR
First Name:TERA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 ARBOR XING SE APT 318
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5561
Mailing Address - Country:US
Mailing Address - Phone:239-628-9951
Mailing Address - Fax:
Practice Address - Street 1:2209 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4843
Practice Address - Country:US
Practice Address - Phone:320-815-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist