Individual
GINA C. BOSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
12716 NE 36TH ST, SPENCER, OK 73084-9167
(405) 769-3301
(405) 769-9685
Mailing address
PO BOX 30589, MIDWEST CITY, OK 73140-3589
(405) 769-3301
(405) 769-9685
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
42594
OK
122300000X
Dentist
Primary
4991
OK
1223G0001X
General Practice Dentistry
Primary
42594
OK
1223G0001X
General Practice Dentistry
4991
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
07/21/2026
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