| Providence Dental Group, Llc | |
|
200 Waterman St Providence RI 02906-4039 | |
| (401) 421-2022 | |
| Not Available |
| Full Name | Providence Dental Group, Llc |
|---|---|
| Speciality | Dentist |
| Location | 200 Waterman St, Providence, Rhode Island |
| Authorized Official Name and Position | Richard Todd Miller (PRESIDENT) |
| Authorized Official Contact | 7815620457 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Dental Group, Llc 500 Chapman St Unit 201 Canton MA 02021-2040 Ph: (617) 383-6687 | Providence Dental Group, Llc 200 Waterman St Providence RI 02906-4039 Ph: (401) 421-2022 |
| NPI Number | 1588140818 |
|---|---|
| Provider Enumeration Date | 07/19/2018 |
| Last Update Date | 07/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588140818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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