Provider Demographics
NPI:1487275574
Name:BOYD, JORDAN ALEXANDRA BYRD (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXANDRA BYRD
Last Name:BOYD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:27 BRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2250
Mailing Address - Country:US
Mailing Address - Phone:540-578-6254
Mailing Address - Fax:
Practice Address - Street 1:161 ASH ST STE B
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3115
Practice Address - Country:US
Practice Address - Phone:781-944-6761
Practice Address - Fax:781-942-1788
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858945122300000X
VA0401417875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty