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Dental Providers Dentist General Practice

Provider NPI: 1215078563

Organization Information:
Authorized Official:  MOURAD  RAHIM  OWNER  401-596-7707

Practice Location:
Tel: 401-596-7707  Fax: 401-596-3645

Business Mailing Address:
Tel: 401-596-7707  Fax: 401-596-3645

NPI Information:
NPI: 1215078563
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223G0001X





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