Individual
DR. RUSSELL ALLEN BOATWRIGHT SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
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
—
Z27757
—
SC
Enumeration date
11/13/2006
Last updated
07/08/2007
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