Healthcare Provider Details

I. General information

NPI: 1063545143
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NEW LONDON AVE
CRANSTON RI
02920-3035
US

IV. Provider business mailing address

245 LAUREL AVE
PROVIDENCE RI
02906-5730
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-7535
  • Fax:
Mailing address:
  • Phone: 401-943-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1726
License Number StateRI

VIII. Authorized Official

Name: DR. STEVEN DENNIS LASSER
Title or Position: PEDIATRIC DENTIST
Credential: D.M.D.
Phone: 401-943-7535