Organization
RUSSELL A. BOATWRIGHT, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL A BOATWRIGHT SR. D.M.D. (PRESIDENT)
(843) 248-2705
Entity
Organization
Contact information
Practice address
1603 10TH AVE, CONWAY, SC 29526-4111
(843) 248-2705
(843) 248-4202
Mailing address
PO BOX 1077, CONWAY, SC 29528-1077
(843) 248-2705
(843) 248-4202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2775
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9860
—
SC
Enumeration date
11/17/2006
Last updated
08/22/2020
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