Organization
SMITH FAMILY DENTAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE SMITH GONCALVES DMD (PRESIDENT)
(401) 434-7471
Entity
Organization
Contact information
Practice address
2780 PAWTUCKET AVENUE, EAST PROVIDENCE, RI 02914
(401) 434-7471
(401) 431-0591
Mailing address
2780 PAWTUCKET AVENUE, EAST PROVIDENCE, RI 02914
(401) 434-7471
(401) 431-0591
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN01418
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MS30181
—
RI
Enumeration date
07/17/2007
Last updated
07/17/2007
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