Provider Demographics
NPI:1033561394
Name:ABBEVILLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ABBEVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-254-8500
Mailing Address - Street 1:405 SLIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4356
Mailing Address - Country:US
Mailing Address - Phone:806-712-4082
Mailing Address - Fax:806-798-1168
Practice Address - Street 1:405 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4356
Practice Address - Country:US
Practice Address - Phone:806-712-4082
Practice Address - Fax:806-798-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty