Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9829784-9922 | UT |
NPI | 1003266057 |
---|---|
Provider Name | Boyd Bandy |
First Address | Saratoga Springs, UT 84045-3201 |
Second Address | Beaver, UT 84713-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 20/06/2016 |