| NPI | 1255697082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARALEE FILLMORE Office Manager 401-822-3352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI 3081) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI 2988) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |