Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | SC3220 | SC |
NPI | 1023012705 |
---|---|
Provider Name | Dr. Michele Boyne |
First Address | Rock Hill, SC 29732-3004 |
Second Address | Rock Hill, SC 29732-3004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/07/2007 |