Healthcare Provider Details

I. General information

NPI: 1013173277
Provider Name (Legal Business Name): ANGELL STREET DENTAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ANGELL ST
PROVIDENCE RI
02906-4403
US

IV. Provider business mailing address

425 ANGELL ST
PROVIDENCE RI
02906-4403
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2331
  • Fax: 401-272-2361
Mailing address:
  • Phone: 401-272-2331
  • Fax: 401-272-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberRI2044
License Number StateRI

VIII. Authorized Official

Name: DR. CHARLES MICHAEL RIOTTO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 401-272-2331