Provider Demographics
NPI:1336127349
Name:BOSWORTH, ROBERT L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BOSWORTH
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 1:2996 BRUCE STA
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4256
Mailing Address - Country:US
Mailing Address - Phone:757-484-4134
Mailing Address - Fax:
Practice Address - Street 1:2996 BRUCE STA
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4256
Practice Address - Country:US
Practice Address - Phone:757-484-4134
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112711223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics