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General NPI Number Information
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NPI Number | 1629353552
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Entity Type | Organization
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Legal Business Name | ASCIOLLA FAMILY DENTISTRY INC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 880 MAIN ST
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3113
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Country | US
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Telephone | 401-884-5242
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Fax | 401-884-9464
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Provider Business Mailing Address
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Address Line | 880 MAIN ST
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3113
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Country | US
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Telephone | 401-884-5242
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Fax | 401-884-9464
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAMELA J KORUS
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Credential |
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Telephone | 401-884-5242
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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 | 02460
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License Number State | RI
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