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Organization
EARL BOSTICK,SR. D.M.D.
Active
Organization
EARL BOSTICK,SR. D.M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL BOSTICK SR. D.M.D. (OWNER)
(843) 726-5711
Entity
Organization
Contact information
Practice address
10832 JACOB SMART BLVD., RIDGELAND, SC 29936-2260
(843) 726-5711
Mailing address
PO BOX 2260, RIDGELAND, SC 29936-2638
(843) 726-5711
(843) 726-5711
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9986
—
SC
Enumeration date
05/23/2007
Last updated
10/10/2011
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