Healthcare Provider Details

I. General information

NPI: 1720137755
Provider Name (Legal Business Name): KENT EARS NOSE & THROAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD
WARWICK RI
02886-4416
US

IV. Provider business mailing address

300 TOLL GATE RD
WARWICK RI
02886-4416
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-1330
  • Fax:
Mailing address:
  • Phone: 401-732-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5410
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5410
License Number StateRI

VIII. Authorized Official

Name: JOANN D. MACMILLAN
Title or Position: DOCTOR
Credential: M.D.
Phone: 401-732-1330