Healthcare Provider Details

I. General information

NPI: 1508020991
Provider Name (Legal Business Name): AQUIDNECK AVENUE FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 AQUIDNECK AVE
MIDDLETOWN RI
02842-7265
US

IV. Provider business mailing address

747 AQUIDNECK AVE
MIDDLETOWN RI
02842-7265
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-9660
  • Fax: 401-846-9667
Mailing address:
  • Phone: 401-846-9660
  • Fax: 401-846-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUNJAY VIJAY PATIL
Title or Position: DENTIST
Credential: D.M.D.
Phone: 401-846-9660