Healthcare Provider Details

I. General information

NPI: 1124158589
Provider Name (Legal Business Name): MATTHEW R ASARO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 COUNTY ROAD
BARRINGTON RI
02806
US

IV. Provider business mailing address

141 COUNTY ROAD
BARRINGTON RI
02806
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-4619
  • Fax: 401-247-0762
Mailing address:
  • Phone: 401-245-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number02543
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number02543
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number02543
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: