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General NPI Number Information
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NPI Number | 1467925529
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTISTRY OF RHODE ISLAND LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 250 WAMPANOAG TRL STE 103
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City | RIVERSIDE
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State | RI
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Zip | 02915-2215
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Country | US
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Telephone | 401-434-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 250 WAMPANOAG TRL STE 103
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City | RIVERSIDE
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State | RI
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Zip | 02915-2215
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Country | US
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Telephone | 401-434-4413
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN S LEE
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Credential |
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Telephone | 617-833-0158
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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