Provider Demographics
NPI:1831153519
Name:BOSWELL, CRAMER LEE (DDS)
Entity type:Individual
Prefix:
First Name:CRAMER
Middle Name:LEE
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:PO BOX 1343
Mailing Address - Street 2:110 NE DEADMORE ST
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212
Mailing Address - Country:US
Mailing Address - Phone:276-628-1327
Mailing Address - Fax:276-628-1427
Practice Address - Street 1:110 NE DEADMORE ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24212
Practice Address - Country:US
Practice Address - Phone:276-628-1327
Practice Address - Fax:276-628-1427
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0043771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7900244Medicaid