| NPI | 1073888798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LELAND S BLOUGH President 401-828-3688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: RI 2455) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |