Organization
PROSPECT CHARTERCARE SJHSRI, LLC
Active
Other names
St. Joseph Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-4321
(401) 456-4369
Mailing address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(401) 456-3000
(401) 456-3028
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/26/2014
Last updated
01/15/2021
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