Healthcare Provider Details

I. General information

NPI: 1942322458
Provider Name (Legal Business Name): THOMAS S. MULVEY DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 POINT STREET SUITE 1
PROVIDENCE RI
02903
US

IV. Provider business mailing address

P.O. BOX 2608
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-3443
  • Fax: 401-272-3539
Mailing address:
  • Phone: 917-566-2652
  • Fax: 401-272-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2821
License Number StateRI

VIII. Authorized Official

Name: DR. THOMAS SPENCER MULVEY
Title or Position: OWNER
Credential: D.D.S.
Phone: 917-566-2652