Provider Demographics
NPI:1972941623
Name:BOYD, RYAN P (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:BOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1903
Mailing Address - Country:US
Mailing Address - Phone:402-533-2222
Mailing Address - Fax:402-426-4989
Practice Address - Street 1:261 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1903
Practice Address - Country:US
Practice Address - Phone:402-533-2222
Practice Address - Fax:426-426-4989
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice