Provider Demographics
NPI:1003087479
Name:BOSWELL ORTHODONTICS
Entity type:Organization
Organization Name:BOSWELL ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAMER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:276-628-1327
Mailing Address - Street 1:110 DEADMORE ST NE
Mailing Address - Street 2:P.O. BOX 1343
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3406
Mailing Address - Country:US
Mailing Address - Phone:276-628-1327
Mailing Address - Fax:276-628-3936
Practice Address - Street 1:110 DEADMORE ST NE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3406
Practice Address - Country:US
Practice Address - Phone:276-628-1327
Practice Address - Fax:276-628-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0043771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007900244Medicaid