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General NPI Number Information
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NPI Number | 1093063026
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Entity Type | Organization
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Legal Business Name | HARRISVILLE DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 262 MAIN ST
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City | HARRISVILLE
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State | RI
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Zip | 02830-1414
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Country | US
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Telephone | 401-568-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 262 MAIN ST
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City | HARRISVILLE
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State | RI
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Zip | 02830-1414
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Country | US
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Telephone | 401-568-3008
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EYAD SALLOUM
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Credential | D.M.D
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Telephone | 617-462-8728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | RI
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