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General NPI Number Information
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NPI Number | 1104234350
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Entity Type | Organization
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Legal Business Name | ZUMSTEIN FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 159 GOVERNOR ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-3062
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Country | US
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Telephone | 401-274-1140
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Fax |
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Provider Business Mailing Address
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Address Line | 159 GOVERNOR ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-3062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | D.D.S
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Name | DR. JUSTIN ZUMSTEIN
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Credential |
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Telephone | 401-274-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2876
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License Number State | RI
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