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111 Point Street Suite 1 Providence RI 02903 | |
| (401) 272-3443 | |
| (401) 272-3539 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 111 Point Street, Providence, Rhode Island |
| Authorized Official Name and Position | Thomas Spencer Mulvey (OWNER) |
| Authorized Official Contact | 9175662652 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 2608 Providence RI 02906 Ph: (917) 566-2652 | 111 Point Street Suite 1 Providence RI 02903 Ph: (401) 272-3443 |
| NPI Number | 1942322458 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 07/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942322458 | NPI | - | NPPES |
| TM51137 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2821 (Rhode Island) | Primary |
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