| NPI | 1912172016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON PAUL VAN REGENMORTER Owner 401-624-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI den02748) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |