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General NPI Number Information
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NPI Number | 1932244076
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Entity Type | Organization
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Legal Business Name | MELLION & CAPPUCCINO, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 265 JEFFERSON BLVD
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City | WARWICK
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State | RI
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Zip | 02888-3823
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Country | US
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Telephone | 401-732-5454
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Fax | 401-738-5173
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Provider Business Mailing Address
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Address Line | 265 JEFFERSON BLVD
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City | WARWICK
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State | RI
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Zip | 02888-3823
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Country | US
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Telephone | 401-732-5454
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Fax | 401-738-5173
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. CONSTANCE M LALIBERTE
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Credential |
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Telephone | 401-732-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1677
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License Number State | RI
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