Provider Demographics
NPI:1700865425
Name:BOSTIC, JOHN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BOSTIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14401 SNOW RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2583
Mailing Address - Country:US
Mailing Address - Phone:216-676-4050
Mailing Address - Fax:216-676-4051
Practice Address - Street 1:14401 SNOW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2583
Practice Address - Country:US
Practice Address - Phone:216-676-4050
Practice Address - Fax:216-676-4051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH157291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice