Healthcare Provider Details

I. General information

NPI: 1013532506
Provider Name (Legal Business Name): DENTAL RI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 OAKLAWN AVE
CRANSTON RI
02920-2621
US

IV. Provider business mailing address

5 LOVEGREEN LN
EAST GREENWICH RI
02818-1163
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-8000
  • Fax:
Mailing address:
  • Phone: 401-533-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ROBERT GALLUCCI
Title or Position: DENTIST
Credential: DMD
Phone: 401-533-3108