Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 056315-1 | NY |
Y | 1223P0700X | Prosthodontist | 056315-1 | NY |
NPI | 1225325830 |
---|---|
Provider Name | Dr. Andrew Wingate Boyd |
First Address | New York, NY 10022-5403 |
Second Address | New York, NY 10022-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2011 |
Last Update Date | 14/12/2015 |