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General NPI Number Information
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NPI Number | 1023442316
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Entity Type | Individual
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Provider Name | JUYOUNG AN
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Gender | Female
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 1090 NEW LONDON AVE
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City | CRANSTON
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State | RI
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Zip | 02920-3035
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Country | US
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Telephone | 401-943-7535
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NEW LONDON AVE
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City | CRANSTON
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State | RI
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Zip | 02920-3035
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Country | US
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Telephone | 401-943-7535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN03251
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License Number State | RI
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