| NPI | 1598222689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE FORTES-WILLIAMS Practice Manager 401-270-1177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2019-02-25 |