Organization
RI DDS (ADIL)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MICROULIS (ADMINISTRATOR)
(401) 222-3182
Entity
Organization
Contact information
Practice address
8 OLIVE ST, PROVIDENCE, RI 02906-1310
(401) 861-2001
Mailing address
8 OLIVE ST, PROVIDENCE, RI 02906-1310
(401) 861-2001
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
MD04710
RI
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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