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General NPI Number Information
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NPI Number | 1003087479
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Entity Type | Organization
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Legal Business Name | BOSWELL ORTHODONTICS
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 110 DEADMORE ST NE
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City | ABINGDON
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State | VA
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Zip | 24210-3406
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Country | US
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Telephone | 276-628-1327
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Fax | 276-628-3936
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Provider Business Mailing Address
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Address Line | 110 DEADMORE ST NE P.O. BOX 1343
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City | ABINGDON
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State | VA
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Zip | 24210-3406
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Country | US
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Telephone | 276-628-1327
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Fax | 276-628-3936
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Authorized Official
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Title or Position | DR.
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Name | DR. CRAMER L. BOSWELL
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Credential | D.D.S., P.C.
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Telephone | 276-628-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 004377
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License Number State | VA
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