MEDICARE: BARBARA MANCINI CAVICCHIO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	RI2017	RI

General Provider Information

NPI Number	:	1528153970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA MANCINI CAVICCHIO D.D.S.

Provider Business Mailing Address
First Line	:	1492 MINERAL SPRING AVENUE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3130
Country	:	US
Telephone Number	:	401-353-4880
Fax Number	:	401-353-1592

Provider Business Practice Location Address
First Line	:	1492 MINERAL SPRING AVENUE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3130
Country	:	US
Telephone Number	:	401-353-4880
Fax Number	:	401-353-1592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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