Healthcare Provider Details

I. General information

NPI: 1235453473
Provider Name (Legal Business Name): MELISSA B GRASWALD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

IV. Provider business mailing address

12 HALIBURTON RD
RUMFORD RI
02916-1418
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-9706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN02716
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: