=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336398502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMIE ITALIANE-DECUBELLIS DDS AND ASSOC. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2008
-----------------------------------------------------
Last Update Date | 09/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 S MAIN ST
-----------------------------------------------------
City | COVENTRY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02816-5911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-828-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 S MAIN ST
-----------------------------------------------------
City | COVENTRY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02816-5911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-828-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER BARBON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-828-7070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 02807
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------