Healthcare Provider Details

I. General information

NPI: 1851466551
Provider Name (Legal Business Name): CONSTANCE MAY COUSINS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

IV. Provider business mailing address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-1992
  • Fax:
Mailing address:
  • Phone: 401-295-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2249
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: