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General NPI Number Information
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NPI Number | 1417231572
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Entity Type | Organization
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Legal Business Name | RI DENTAL CARE INC.
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 868 CHARLES STRETE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5646
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Country | US
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Telephone | 401-729-9500
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Fax | 401-729-9519
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Provider Business Mailing Address
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Address Line | 868 CHARLES ST
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5646
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Country | US
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Telephone | 401-729-9500
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Fax | 401-729-9519
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL KOTUBY
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Credential | DMD
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Telephone | 401-729-9500
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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 | DEN1874
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License Number State | RI
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