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General NPI Number Information
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NPI Number | 1427865328
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Entity Type | Organization
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Legal Business Name | PROVIDENCE ORTHODONTICS, LLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 151 WATERMAN ST STE 6
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City | PROVIDENCE
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State | RI
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Zip | 02906-2118
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Country | US
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Telephone | 401-274-5024
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Fax |
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Provider Business Mailing Address
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Address Line | 151 WATERMAN ST STE 6
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City | PROVIDENCE
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State | RI
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Zip | 02906-2118
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Country | US
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Telephone | 401-274-5024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIRSTEN L ROMANI
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Credential |
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Telephone | 401-573-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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