Healthcare Provider Details

I. General information

NPI: 1346674066
Provider Name (Legal Business Name): ANTHONY J. TILELLI DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 COWESETT AVE
WEST WARWICK RI
02893-2222
US

IV. Provider business mailing address

336 COWESETT AVE
WEST WARWICK RI
02893-2222
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-2400
  • Fax: 401-828-0051
Mailing address:
  • Phone: 401-828-2400
  • Fax: 401-828-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3116
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1731
License Number StateRI

VIII. Authorized Official

Name: DR. ANTHONY J TILELLI
Title or Position: OWNER
Credential: DDS
Phone: 401-828-2400