Boatwright, Russell Allen

Boatwright, Russell Allen is an individual health care provider with primary practice located at 1603 10Th Ave , Conway SC 29526-4111. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Boatwright, Russell Allen can be contacted via phone (843) 248-2705.

Contact Information

Primary practice address
1603 10Th Ave Conway SC 29526-4111
Phone: (843) 248-2705
Fax: (843) 248-4202
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2775 South Carolina

Profile Details

NPI number 1174694004
LBN Legal business name Boatwright, Russell Allen
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174694004 NPPES
South Carolina MEDICAID Z27757

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