Healthcare Provider Details

I. General information

NPI: 1639564891
Provider Name (Legal Business Name): NEW ENGLAND DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 BROAD STREET
PROVIDENCE RI
02905
US

IV. Provider business mailing address

1387 BROAD STREET
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-451-6546
  • Fax:
Mailing address:
  • Phone: 401-451-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3210
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NELFA M CESPEDES
Title or Position: OWNER
Credential: DDS
Phone: 401-781-4424