Healthcare Provider Details

I. General information

NPI: 1689898678
Provider Name (Legal Business Name): DENTAL SERVICES , P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TOLL GATE RD
WARWICK RI
02886-4444
US

IV. Provider business mailing address

69 GOVERNOR ST
PROVIDENCE RI
02906-3008
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-9363
  • Fax: 401-737-1231
Mailing address:
  • Phone: 401-749-2345
  • Fax: 401-274-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN02883
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number207L00000X
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. WAYLAND ANTONIO EASLEY
Title or Position: CEO
Credential: DDS
Phone: 401-749-2345