# CGHE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ATWILL CONROY DENTAL ASSOCIATES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750680435
- **Authorized official:** DR. KRISTOFER HAGGARTY DMD (MEMBER)
- **Authorized official phone:** (401) 351-3090

## Contact information

- **Practice address:** 1196 SMITH ST, PROVIDENCE, RI 02908-2036
- **Practice address phone:** (401) 351-3090
- **Practice address fax:** (401) 331-1315
- **Mailing address:** 1196 SMITH ST, PROVIDENCE, RI 02908-2036
- **Mailing address phone:** (401) 351-3090
- **Mailing address fax:** (401) 331-1315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2350 | RI | — |
| 1223G0001X | General Practice Dentistry | 2663 | RI | — |
| 1223G0001X | General Practice Dentistry | 2744 | RI | Yes |
| 1223G0001X | General Practice Dentistry | 2837 | RI | — |

## Other

- **Enumeration date:** 03/21/2011
- **Last updated:** 03/21/2011