| City Dental, Llc | |
|
314f Pocasset Avenue Providence RI 02909 | |
| (401) 942-5051 | |
| (401) 942-5156 |
| Full Name | City Dental, Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 314f Pocasset Avenue, Providence, Rhode Island |
| Authorized Official Name and Position | Cielito R Deayala (MANAGER) |
| Authorized Official Contact | 4019425051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| City Dental, Llc 314f Pocasset Avenue Providence RI 02909 Ph: (401) 942-5051 | City Dental, Llc 314f Pocasset Avenue Providence RI 02909 Ph: (401) 942-5051 |
| NPI Number | 1477736452 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 12/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477736452 | NPI | - | NPPES |
| DEN02737 | Other | RI | DMD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DEN02737 (Rhode Island) | Secondary |
| 1223P0300X | Dentist - Periodontics | DEN02637 (Rhode Island) | Primary |
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