| NPI | 1841398658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT M FERTIK President 401-274-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN02345) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN02700) |
| 122300000X Dentist (Licence: RI DEN01328) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |