Healthcare Provider Details

I. General information

NPI: 1336942978
Provider Name (Legal Business Name): DEIDRE FLYNN DAHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 IMPERIAL PL UNIT 203
PROVIDENCE RI
02903-4638
US

IV. Provider business mailing address

240 SHADY HILL DR
EAST GREENWICH RI
02818-1404
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-8160
  • Fax:
Mailing address:
  • Phone: 401-275-3570
  • Fax: 401-275-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDACM00117
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: