Organization
PERIODONTAL ASSOCIATES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE HUMPHREY (MANAGER)
(401) 421-6464
Entity
Organization
Contact information
Practice address
189 GOVERNOR ST, PROVIDENCE, RI 02906-3124
(401) 421-6464
(401) 272-3884
Mailing address
189 GOVERNOR ST, PROVIDENCE, RI 02906-3124
(401) 421-6464
(401) 272-3884
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1484
RI
122300000X
Dentist
2740
RI
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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