Individual
GINA C. BOSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1901 SPRINGLAKE DR, OKLAHOMA CITY, OK 73111-5201
(405) 521-8486
(405) 521-8496
Mailing address
1901 SPRINGLAKE DR, OKLAHOMA CITY, OK 73111-5201
(405) 419-9800
(405) 769-9685
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
42594
OK
1223G0001X
General Practice Dentistry
Primary
42594
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100131420A
—
OK
01
—
19915
BNDD
OK
01
—
42594
DENTAL LICENSE
OK
Enumeration date
12/01/2005
Last updated
03/07/2023
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