Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 00087 | AZ |
Y | 124Q00000X | Dental Hygienist | H06758 | AZ |
NPI | 1194189878 |
---|---|
Provider Name | Thana Dawn Boyd |
First Address | Phoenix, AZ 85012-3330 |
Second Address | Phoenix, AZ 85012-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 08/04/2016 |