Provider Demographics
NPI:1104074947
Name:DR JOHN P. BOYLE, FAMILY DENTISTRY
Entity type:Organization
Organization Name:DR JOHN P. BOYLE, FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-683-6955
Mailing Address - Street 1:15295 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-8706
Mailing Address - Country:US
Mailing Address - Phone:610-683-6955
Mailing Address - Fax:610-683-6954
Practice Address - Street 1:15295 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-8706
Practice Address - Country:US
Practice Address - Phone:610-683-6955
Practice Address - Fax:610-683-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022152L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty