Individual
DR. JOANNA LEA BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
504 FOXWILD CT, SIMPSONVILLE, SC 29681-7299
(318) 680-8226
Mailing address
504 FOXWILD CT, SIMPSONVILLE, SC 29681-7299
(318) 680-8226
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9885
SC
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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