Healthcare Provider Details

I. General information

NPI: 1639628993
Provider Name (Legal Business Name): PAOLUCCI LINCOLN DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL SUITE 306A
LINCOLN RI
02865-1179
US

IV. Provider business mailing address

6 BLACKSTONE VALLEY PL SUITE 306A
LINCOLN RI
02865-1179
US

V. Phone/Fax

Practice location:
  • Phone: 401-333-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberDEN03270
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK LOUIS PAOLUCCI
Title or Position: DENTIST
Credential:
Phone: 401-333-5500