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General NPI Number Information
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NPI Number | 1457623985
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Entity Type | Organization
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Legal Business Name | RUMFORD DENTAL, INC.
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 20 NEWMAN AVE SUITE 1020
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City | RUMFORD
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State | RI
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Zip | 02916-1960
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Country | US
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Telephone | 401-434-4304
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Fax |
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Provider Business Mailing Address
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Address Line | 20 NEWMAN AVE SUITE 1020
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City | RUMFORD
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State | RI
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Zip | 02916-1960
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Country | US
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Telephone | 401-434-4304
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTORIA JEAN BAEGER
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Credential | DMD
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Telephone | 401-434-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 03103
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License Number State | RI
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