Russell a. Boatwright, D.M.D., P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2775 Issued in SC

Legal business name

RUSSELL A. BOATWRIGHT, D.M.D., P.C.

Practice address

1603 10TH Ave
Conway, SC 29526-4111

Phone

(843) 248-2705

Fax

(843) 248-4202

NPI assigned

Nov 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Russell A Boatwright Sr., D.M.D.NPI 1174694004

Title

President

Phone

(843) 248-2705

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Russell Allen Boatwright Sr., D.M.D.

  • General Practice Dentistry
  • Conway, SC
  • NPI 1174694004

  General Practice

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114091600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1077",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295281077",
            "telephone_number": "843-248-2705",
            "fax_number": "843-248-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 10TH AVE",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295264111",
            "telephone_number": "843-248-2705",
            "fax_number": "843-248-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL A. BOATWRIGHT, D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOATWRIGHT",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-248-2705",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9860",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Jeffords Rowell
• Jennifer Sue Roy, APRN
• Amanda Jean Ruby, NP
• Aldo Justin Ruffolo
• Karen A Rushford, C.N.M.
• Cheryl Anderson Russell, MA
• Dianne Margaret Ryan, ARNP
• Kelly Ann Ryder, BSN, RN
• S.C. Department of Health and Environmental Control
• Anam Ali Sabzwari, MD

• All providers in Conway, SC
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.