Provider Demographics
NPI:1528120979
Name:BOYKIN, RUTH (DMD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N PLEASANTBURG DR
Mailing Address - Street 2:STE. D
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1256
Mailing Address - Country:US
Mailing Address - Phone:864-268-5611
Mailing Address - Fax:864-268-0503
Practice Address - Street 1:1140 N PLEASANTBURG DR
Practice Address - Street 2:STE. D
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1256
Practice Address - Country:US
Practice Address - Phone:864-268-5611
Practice Address - Fax:864-268-0503
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9645Medicaid