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General NPI Number Information
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NPI Number | 1568042539
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL INC
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 41 SANDERSON RD STE 106
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City | SMITHFIELD
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State | RI
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Zip | 02917-2611
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Country | US
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Telephone | 401-349-3290
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Fax | 401-349-3291
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Provider Business Mailing Address
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Address Line | 41 SANDERSON RD STE 106
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City | SMITHFIELD
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State | RI
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Zip | 02917-2611
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Country | US
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Telephone | 401-349-3290
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Fax | 401-349-3291
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Authorized Official
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Title or Position | DR, OWNER,
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Name | DR. MAHA MAAITA
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Credential | DMD
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Telephone | 401-349-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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