| NPI | 1104221738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILFREDO LUANING SANCIANCO Owner/Dentist 401-737-7715 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: RI 02633) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-24 |