| Russell A. Boatwright, D.m.d., P.c. | |
|
1603 10th Ave Conway SC 29526-4111 | |
| (843) 248-2705 | |
| (843) 248-4202 |
| Full Name | Russell A. Boatwright, D.m.d., P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1603 10th Ave, Conway, South Carolina |
| Authorized Official Name and Position | Russell A Boatwright (PRESIDENT) |
| Authorized Official Contact | 8432482705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell A. Boatwright, D.m.d., P.c. Po Box 1077 Conway SC 29528-1077 Ph: (843) 248-2705 | Russell A. Boatwright, D.m.d., P.c. 1603 10th Ave Conway SC 29526-4111 Ph: (843) 248-2705 |
| NPI Number | 1114091600 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114091600 | NPI | - | NPPES |
| ZA9860 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2775 (South Carolina) | Primary |
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