Healthcare Provider Details

I. General information

NPI: 1659350312
Provider Name (Legal Business Name): MANSOLILLO MANSOLILLO & MANSOLILLO DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 HARTFORD AVE
JOHNSTON RI
02919
US

IV. Provider business mailing address

1347 HARTFORD AVE
JOHNSTON RI
02919
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-1080
  • Fax: 401-861-5706
Mailing address:
  • Phone: 401-861-1080
  • Fax: 401-861-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH LEWIS MANSOLILLO
Title or Position: PARTNER
Credential: DDS
Phone: 401-861-1080