Healthcare Provider Details

I. General information

NPI: 1790192540
Provider Name (Legal Business Name): ROVATI DENTAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 CRANSTON ST
CRANSTON RI
02920-6758
US

IV. Provider business mailing address

1370 CRANSTON ST
CRANSTON RI
02920-6758
US

V. Phone/Fax

Practice location:
  • Phone: 401-942-5051
  • Fax:
Mailing address:
  • Phone: 401-942-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN0267
License Number StateRI

VIII. Authorized Official

Name: DR. ITALO LOZADA
Title or Position: DENTIST
Credential: DMD, DDS
Phone: 401-942-5051