Individual
DR. FARISA SURATTANONT MULVEY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
148 WATERMAN ST, PROVIDENCE, RI 02906-2130
(401) 272-3443
(401) 272-3539
Mailing address
148 WATERMAN ST, P.O. BOX 2608, PROVIDENCE, RI 02906-2130
(401) 272-3443
(401) 272-3539
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2834
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FS53913
—
RI
Enumeration date
05/12/2006
Last updated
07/09/2007
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