Individual provider Active NPI

William J Boyd Jr., DMD

  • General Practice Dentistry
  • Travelers Rest, SC
National Provider Identifier
1679003156
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10943 Issued in SC
Practice address
125 Botanical Cir
Travelers Rest, SC 29690-7112
Phone
(864) 836-3611
NPI assigned
Jun 15, 2017
Last updated
Jan 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9729 AZ
General Practice Dentistry 1223G0001X 10943 SC Primary

Addresses

Primary practice location

125 Botanical Cir
Travelers Rest, SC 29690-7112

Mailing address

125 Botanical Cir
Travelers Rest, SC 29690-7112
Phone (864) 836-3611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171102002879 AZ Order and Referring Only - DentistPractitioner - Dentist 5193081461

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9729AZMDDentist
10943SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
The Dental Retreat LLC General Practice CurrentSince Dec 1, 2024 Accepting new patients
Marketplace Smiles, LLP General Practice Past Accepting new patients
The Dental Retreat at Mountain Park PastSince Nov 17, 2024 Accepting new patients

Locations

125 Botanical Cir
Travelers Rest, SC 29690
Phone (602) 502-4540

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1679003156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BOTANICAL CIR",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296907112",
            "telephone_number": "864-836-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BOTANICAL CIR",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296907112",
            "telephone_number": "864-836-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYD",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "9729",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travelers Rest, SC

Sources for this page

Verify at the official NPI Registry.