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General NPI Number Information
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NPI Number | 1558520155
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Entity Type | Organization
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Legal Business Name | WARWICK FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 819 GREENWICH AVE
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City | WARWICK
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State | RI
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Zip | 02886-1815
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Country | US
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Telephone | 401-739-8337
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Fax | 410-732-3341
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Provider Business Mailing Address
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Address Line | 819 GREENWICH AVE
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City | WARWICK
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State | RI
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Zip | 02886-1815
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Country | US
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Telephone | 401-739-8337
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Fax | 401-732-3341
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUN H YOON
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Credential | D.M.D.
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Telephone | 401-739-8337
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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 | 1760
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License Number State | RI
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