| Periodontal Associates, Ltd. | |
|
189 Governor St Providence RI 02906-3124 | |
| (401) 421-6464 | |
| (401) 272-3884 |
| Full Name | Periodontal Associates, Ltd. |
|---|---|
| Speciality | Dentist |
| Location | 189 Governor St, Providence, Rhode Island |
| Authorized Official Name and Position | Diane Humphrey (MANAGER) |
| Authorized Official Contact | 4014216464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontal Associates, Ltd. 189 Governor St Providence RI 02906-3124 Ph: (401) 421-6464 | Periodontal Associates, Ltd. 189 Governor St Providence RI 02906-3124 Ph: (401) 421-6464 |
| NPI Number | 1295983781 |
|---|---|
| Provider Enumeration Date | 09/09/2008 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295983781 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1484 (Rhode Island) | Primary |
| 122300000X | Dentist | 2740 (Rhode Island) | Secondary |
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