Provider Demographics
NPI:1194721555
Name:BOYD, DOUGLAS C (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:BOYD
Suffix:
Gender:M
Credentials:DMD, MS
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 6323
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6323
Mailing Address - Country:US
Mailing Address - Phone:503-257-0545
Mailing Address - Fax:
Practice Address - Street 1:13908 SE STARK ST
Practice Address - Street 2:STE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2161
Practice Address - Country:US
Practice Address - Phone:503-257-0545
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR45971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics