Healthcare Provider Details

I. General information

NPI: 1770679581
Provider Name (Legal Business Name): FOTINI DIONISOPOULOS D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NEW LONDON AVENUE
CRANSTON RI
02920
US

IV. Provider business mailing address

5 BAYBERRY COURT
LINCOLN RI
02865
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-7535
  • Fax: 401-463-5693
Mailing address:
  • Phone: 401-943-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number02845
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: