Provider Demographics
NPI:1992711238
Name:BOYLES, DENNIS DWIGHT (LAC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:DWIGHT
Last Name:BOYLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 SE 170TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1741
Mailing Address - Country:US
Mailing Address - Phone:503-228-4533
Mailing Address - Fax:
Practice Address - Street 1:232 NW 6TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3609
Practice Address - Country:US
Practice Address - Phone:503-226-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00928171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist