| NPI | 1861439705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RILWAN FEYISITAN CEO 401-848-6697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: RI 01520) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2025-03-11 |