| NPI | 1689898678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYLAND ANTONIO EASLEY CEO 401-749-2345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI 122300000) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 122300000X) |
| 207L00000X Anesthesiology (Licence: RI 207L00000X) | |
| 261QD0000X Clinic/Center, Dental (Licence: RI DEN02883) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |