Provider Demographics
NPI:1912524653
Name:BOYD, RICHARD EDWARD JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 HICKORY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2621
Mailing Address - Country:US
Mailing Address - Phone:804-788-7000
Mailing Address - Fax:
Practice Address - Street 1:5237 HICKORY PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2621
Practice Address - Country:US
Practice Address - Phone:804-788-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014173021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics