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Organization

STONE BRIDGE DENTAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PAUL BAZZONI DDS (EMPLOYEE)
(401) 624-2375
Entity
Organization

Contact information

Practice address
1750 MAIN RD, TIVERTON, RI 02878-4538
(401) 624-2375
Mailing address
1750 MAIN RD, TIVERTON, RI 02878-4538
(401) 624-2375

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1864
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8931-3
BLUE CROSS BLUE SHIELD
RI
Enumeration date
12/01/2008
Last updated
12/01/2008
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