| NPI | 1295983781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE HUMPHREY Manager 401-421-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI 1484) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI 2740) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2008-09-09 |