Organization · NPI-2

31 Elmgrove Dental LLC

Dentist, General Practice · Providence, RI

NPI number1225787708
StatusActive
Last updated in NPPESMar 22, 2022

Details

NPI
1225787708
Entity type
Organization (NPI-2)
Legal business name
31 Elmgrove Dental LLC
Organization subpart
No
Enumeration date
Mar 22, 2022
Certification date
Mar 8, 2022
Last updated
Mar 22, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes

Other names

  • Dr Lawrence D Page Dmd INC (Former Legal Business Name)

Practice location

31 Elmgrove Ave
Providence, RI 02906-4103

Phone 401-421-9350 · Fax 401-421-6450

Mailing address

31 Elmgrove Ave
Providence, RI 02906-4103

Authorized official

Jessica A Polak
Office Manager
4014219350

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