Organization
31 ELMGROVE DENTAL LLC
Active
Other names
dr lawrence d page dmd inc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA A POLAK CDA (OFFICE MANAGER)
(401) 421-9350
Entity
Organization
Contact information
Practice address
31 ELMGROVE AVE, PROVIDENCE, RI 02906-4103
(401) 421-9350
(401) 421-6450
Mailing address
31 ELMGROVE AVE, PROVIDENCE, RI 02906-4103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MP01974
—
RI
Enumeration date
03/22/2022
Last updated
03/22/2022
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