| NPI | 1427586775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM GORDON Owner 401-828-1171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI DEN03331) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: RI RI2421) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |