Healthcare Provider Details

I. General information

NPI: 1720192180
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF NO. SMITHFIELD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 VICTORY HIGHWAY
SLATERSVILLE RI
02876-0130
US

IV. Provider business mailing address

PO BOX 130
SLATERSVILLE RI
02876-0130
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-2800
  • Fax: 401-765-2805
Mailing address:
  • Phone: 401-766-2800
  • Fax: 401-765-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN02664
License Number StateRI

VIII. Authorized Official

Name: JOSEPH MALLOUH
Title or Position: SOLE PROPRIETOR
Credential: D.D.S.
Phone: 401-766-2800