Organization
PERIODONTAL ASSOCIATES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAYEZ G BADLISSI DMD (OWNER)
(401) 421-6464
Entity
Organization
Contact information
Practice address
189 GOVERNOR ST, PROVIDENCE, RI 02906-3124
(401) 421-6464
Mailing address
189 GOVERNOR ST, PROVIDENCE, RI 02906-3124
(401) 421-6464
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3206
RI
Other
Enumeration date
05/02/2014
Last updated
05/02/2014
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