=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790952174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST BAY DENTAL ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1052 MAIN ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02885-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-245-8444
-----------------------------------------------------
Fax | 401-245-9170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1052 MAIN ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02885-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-245-8444
-----------------------------------------------------
Fax | 401-245-9170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS P. ENRIGHT
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 401-245-8444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------