Individual
KELVIN BOSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
10832 N JACOB SMART BLVD, RIDGELAND, SC 29936-2707
(843) 726-5711
Mailing address
PO BOX 2260, RIDGELAND, SC 29936-2638
(843) 726-5711
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.8660 GD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457372948
—
SC
Enumeration date
10/26/2015
Last updated
10/26/2015
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