Healthcare Provider Details

I. General information

NPI: 1063767663
Provider Name (Legal Business Name): MELANIE K. DUFOUR-PILNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 MAIN ST
HOPE VALLEY RI
02832-1608
US

IV. Provider business mailing address

1035 MAIN ST
HOPE VALLEY RI
02832-1608
US

V. Phone/Fax

Practice location:
  • Phone: 401-539-1090
  • Fax: 401-539-7460
Mailing address:
  • Phone: 401-539-1090
  • Fax: 401-539-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2167
License Number StateRI

VIII. Authorized Official

Name: MELANIE K DUFOUR-PILNY
Title or Position: OWNER
Credential: D.M.D.
Phone: 401-539-1090