Basic Information
| Provider Information | |||||||||
| NPI: | 1265556468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYNTON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 N UNIVERSITY | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481091078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347632331 | ||||||||
| FaxNumber: | 7347638100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DR | ||||||||
| Address2: | B1B204 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481090018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347632331 | ||||||||
| FaxNumber: | 7347638100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901018557 | MI | X | Dental Providers | Dentist | 1223P0221X | 2901018557 | MI | X | Dental Providers | Dentist | Pediatric Dentistry |
ID Information
| ID | Type | State | Issuer | Description | 4784437 | 05 | MI | MEDICAID | 1958112000 | 01 | MI | BCBS OF MI MED SURGICAL | OTHER | 2667592 | 05 | OH | MEDICAID | 4784428 | 05 | MI | MEDICAID | D185570 | 01 | MI | BCBS OF MI DENTAL | OTHER |