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General NPI Number Information
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NPI Number | 1497888168
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY & DENTAL IMPLANT CENTER INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 03/23/2024
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Provider Practice Location Address
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Address Line | 65 W MAIN RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-4933
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Country | US
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Telephone | 401-848-0070
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Fax | 401-848-2225
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Provider Business Mailing Address
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Address Line | 65 W MAIN RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-4933
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Country | US
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Telephone | 401-848-0070
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Fax | 401-848-2225
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. VALERIE MERCER
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Credential |
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Telephone | 401-848-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN2276
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License Number State | RI
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