Organization
CITY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CIELITO R DEAYALA (MANAGER)
(401) 942-5051
Entity
Organization
Contact information
Practice address
314F POCASSET AVENUE, PROVIDENCE, RI 02909
(401) 942-5051
(401) 942-5156
Mailing address
314F POCASSET AVENUE, PROVIDENCE, RI 02909
(401) 942-5051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DEN02737
RI
1223P0300X
Periodontics
Primary
DEN02637
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN02737
DMD
RI
Enumeration date
12/12/2007
Last updated
12/12/2007
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