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General NPI Number Information
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NPI Number | 1184084378
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Entity Type | Organization
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Legal Business Name | FUNSMILES, INC
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 123 SCHOOL ST STE 1
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City | PAWTUCKET
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State | RI
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Zip | 02860-4203
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Country | US
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Telephone | 401-834-1200
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Fax | 401-834-1201
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Provider Business Mailing Address
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Address Line | 123 SCHOOL ST STE 1
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City | PAWTUCKET
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State | RI
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Zip | 02860-4203
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Country | US
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Telephone | 401-834-1200
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Fax | 401-834-1201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHEILA LIONHEART BRIJADE
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Credential | DDS,MS
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Telephone | 401-834-1200
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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 | DEN03218
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License Number State | RI
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