Healthcare Provider Details

I. General information

NPI: 1518906965
Provider Name (Legal Business Name): EAST SIDE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WATERMAN ST
PROVIDENCE RI
02906-2010
US

IV. Provider business mailing address

130 WATERMAN ST
PROVIDENCE RI
02906-2010
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-3746
  • Fax: 401-521-0037
Mailing address:
  • Phone: 401-521-3746
  • Fax: 401-521-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2173
License Number StateRI

VIII. Authorized Official

Name: DR. JANET S TANZI
Title or Position: OWNER
Credential: D.D.S.
Phone: 401-521-3746