Deborah Boykin Broyles, DMD
Individual provider Active NPI Dentist · Clinton, NC
NPI 1285642249 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285642249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5698 (NC)
- Practice address
- 603 Beaman Street Suite 101
Clinton, NC 28328-2695 - Phone
- (910) 592-3613
- Fax
- (910) 592-7808
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5698 | NC | MD | Dentist |
| 2912 | SC | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5698 | NC | Yes |
| Dentist | 122300000X | 2912 | SC |
Addresses
Primary practice location
603 Beaman Street Suite 101
Clinton, NC 28328-2695
Mailing address
603 Beaman Street Suite 101
Clinton, NC 28328-2695
Phone (910) 592-3613
Other providers in Clinton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.