Organization
BOUSTANI PERIODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GABRIEL BOUSTANI DMD, MSD (PRESIDENT)
(617) 640-4637
Entity
Organization
Contact information
Practice address
40 ELMGROVE AVE, PROVIDENCE, RI 02906-4104
(401) 421-1717
(401) 421-0066
Mailing address
40 ELMGROVE AVE, PROVIDENCE, RI 02906-4104
(401) 421-1717
(401) 421-0066
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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