Healthcare Provider Details

I. General information

NPI: 1922925221
Provider Name (Legal Business Name): WATERMAN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WATERMAN ST STE 4
PROVIDENCE RI
02906-2118
US

IV. Provider business mailing address

151 WATERMAN ST STE 4
PROVIDENCE RI
02906-2118
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2743
  • Fax:
Mailing address:
  • Phone: 401-274-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: YUJIN LEE
Title or Position: DENTIST/EMPLOYER
Credential: DMD
Phone: 401-297-5294