Provider Demographics
NPI:1083633838
Name:BOSWELL, PHILIP T (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4243
Mailing Address - Country:US
Mailing Address - Phone:770-227-8020
Mailing Address - Fax:770-227-7033
Practice Address - Street 1:675 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4243
Practice Address - Country:US
Practice Address - Phone:770-227-8020
Practice Address - Fax:770-227-7033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0072821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice