| 31 Elmgrove Dental Llc | |
|
31 Elmgrove Ave Providence RI 02906-4103 | |
| (401) 421-9350 | |
| (401) 421-6450 |
| Full Name | 31 Elmgrove Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 31 Elmgrove Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Jessica A Polak (OFFICE MANAGER) |
| Authorized Official Contact | 4014219350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 31 Elmgrove Dental Llc 31 Elmgrove Ave Providence RI 02906-4103 Ph: () - | 31 Elmgrove Dental Llc 31 Elmgrove Ave Providence RI 02906-4103 Ph: (401) 421-9350 |
| NPI Number | 1225787708 |
|---|---|
| Provider Enumeration Date | 03/22/2022 |
| Last Update Date | 03/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225787708 | NPI | - | NPPES |
| MP01974 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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