Healthcare Provider Details

I. General information

NPI: 1104234350
Provider Name (Legal Business Name): ZUMSTEIN FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 GOVERNOR ST
PROVIDENCE RI
02906-3062
US

IV. Provider business mailing address

159 GOVERNOR ST
PROVIDENCE RI
02906-3062
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2876
License Number StateRI

VIII. Authorized Official

Name: DR. JUSTIN ZUMSTEIN
Title or Position: D.D.S
Credential:
Phone: 401-274-1140