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General NPI Number Information
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NPI Number | 1952734949
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CARE OF RHODE ISLAND
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 1775 BALD HILL RD
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City | WARWICK
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State | RI
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Zip | 02886-4231
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Country | US
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Telephone | 401-825-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 BALD HILL RD
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City | WARWICK
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State | RI
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Zip | 02886-4231
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Country | US
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Telephone | 401-825-6062
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/OWNER
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Name | DR. JASON HENCLER
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Credential | DMD
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Telephone | 401-825-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN03114
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License Number State | RI
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