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General NPI Number Information
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NPI Number | 1427242973
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Entity Type | Organization
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Legal Business Name | MAPLE AVENUE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 310 MAPLE AVE SUITE 107
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City | BARRINGTON
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State | RI
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Zip | 02806-3430
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Country | US
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Telephone | 401-247-2200
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Fax | 401-247-2295
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Provider Business Mailing Address
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Address Line | 310 MAPLE AVE SUITE 107
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City | BARRINGTON
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State | RI
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Zip | 02806-3430
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Country | US
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Telephone | 401-247-2200
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Fax | 401-247-2295
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA BARONE JR.
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Credential | DDS
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Telephone | 401-247-2200
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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 | DEN02380
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License Number State | RI
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