Provider Demographics
NPI:1457508483
Name:VERNON O BOSWELL DDS
Entity Type:Organization
Organization Name:VERNON O BOSWELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:OLEN
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-297-9333
Mailing Address - Street 1:115 NORTH DIXIE DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-297-9333
Mailing Address - Fax:979-297-9996
Practice Address - Street 1:115 NORTH DIXIE DRIVE
Practice Address - Street 2:SUITE 410
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-9996
Practice Address - Fax:979-297-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty