Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6191 | LA |
NPI | 1003124397 |
---|---|
Provider Name | Dr. Jared Michael Boyd |
First Address | Shreveport, LA 71104-2125 |
Second Address | Shreveport, LA 71104-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2010 |
Last Update Date | 14/03/2017 |