Healthcare Provider Details

I. General information

NPI: 1912832510
Provider Name (Legal Business Name): MADELINE LARRIMORE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335R PRAIRIE AVE
PROVIDENCE RI
02905-2426
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0430
  • Fax: 401-444-0489
Mailing address:
  • Phone: 401-444-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03868
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: