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General NPI Number Information
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NPI Number | 1689658700
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Entity Type | Individual
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Provider Name | GINA C. BOSTICK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1901 SPRINGLAKE DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73111-5201
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Country | US
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Telephone | 405-521-8486
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Fax | 405-521-8496
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Provider Business Mailing Address
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Address Line | 1901 SPRINGLAKE DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73111-5201
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Country | US
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Telephone | 405-419-9800
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Fax | 405-769-9685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 42594
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42594
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License Number State | OK
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