Healthcare Provider Details

I. General information

NPI: 1649322736
Provider Name (Legal Business Name): SHIRLEY ANN SPATER FREEDMAN DMD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY ANN SPATER DMD MPH

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET SAMUELS SINCLAIR DENTAL CENTER AT RIH
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY STREET SAMUELS SINCLAIR DENTAL CENTER AT RIH
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5995
  • Fax: 401-444-3494
Mailing address:
  • Phone: 401-444-5995
  • Fax: 401-444-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN02521
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: