Provider Demographics
NPI:1285786616
Name:BOSWORTH, INC A DENTAL CORPORATION
Entity type:Organization
Organization Name:BOSWORTH, INC A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:858-292-4566
Mailing Address - Street 1:7675 DAGGET ST
Mailing Address - Street 2:#160
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2200
Mailing Address - Country:US
Mailing Address - Phone:858-292-4566
Mailing Address - Fax:858-292-5217
Practice Address - Street 1:7675 DAGGET ST
Practice Address - Street 2:#160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2200
Practice Address - Country:US
Practice Address - Phone:858-292-4566
Practice Address - Fax:858-292-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty