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Organization
PETRA DIAGNOSTICS
Active
Organization
PETRA DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA W. TYLER DMD (PRESIDENT)
(401) 295-0260
Entity
Organization
Contact information
Practice address
350 KINGSTOWN RD, SUITE 203, NARRAGANSETT, RI 02882-3262
(401) 284-3500
(401) 284-3502
Mailing address
350 KINGSTOWN RD, SUITE 203, NARRAGANSETT, RI 02882-3262
(401) 284-3500
(401) 284-3502
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2494
RI
Other
Enumeration date
08/26/2009
Last updated
08/26/2009
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