| NPI | 1013483981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MATOS Bookkeeper 401-334-3070 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2018-10-18 |