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General NPI Number Information
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NPI Number | 1518562750
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Entity Type | Organization
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Legal Business Name | YOUR PROFILE DENTAL, LLC
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 888 BROADWAY
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-3742
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Country | US
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Telephone | 401-228-3999
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Fax | 401-228-3966
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Provider Business Mailing Address
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Address Line | 888 BROADWAY
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-3742
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Country | US
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Telephone | 401-228-3999
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Fax | 401-228-3966
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EMILY FERREIRA
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Credential |
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Telephone | 401-228-3999
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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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