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General NPI Number Information
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NPI Number | 1083883722
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Entity Type | Organization
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Legal Business Name | JERRY L. BOSHELL, D.M.D., P.C.
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1606 6TH AVE S
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City | JASPER
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State | AL
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Zip | 35501-4640
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Country | US
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Telephone | 205-221-2330
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Fax | 205-221-3961
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Provider Business Mailing Address
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Address Line | 1606 6TH AVE S P.O. BOX 3125
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City | JASPER
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State | AL
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Zip | 35501-4640
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Country | US
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Telephone | 205-221-2330
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Fax | 205-221-3961
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY L. BOSHELL
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Credential | D.M.D., PH.D.
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Telephone | 205-221-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3149
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License Number State | AL
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