Healthcare Provider Details

I. General information

NPI: 1336127349
Provider Name (Legal Business Name): ROBERT L BOSWORTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 BRUCE STA
CHESAPEAKE VA
23321-4256
US

IV. Provider business mailing address

2996 BRUCE STA
CHESAPEAKE VA
23321-4256
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-4134
  • Fax:
Mailing address:
  • Phone: 757-484-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401411271
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: