Healthcare Provider Details

I. General information

NPI: 1972569317
Provider Name (Legal Business Name): KAJA PUERINI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAJA STYCZYNSKA

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRIDGE WAY WELLONE PRIMARY MEDICAL AND DENTAL CARE
PASCOAG RI
02859-3131
US

IV. Provider business mailing address

PO BOX 312 WELLONE PRIMARY MEDICAL AND DENTAL CARE
PASCOAG RI
02859-0312
US

V. Phone/Fax

Practice location:
  • Phone: 401-567-0800
  • Fax: 401-568-0582
Mailing address:
  • Phone: 401-567-0800
  • Fax: 401-567-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN02891
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN02891
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: