Individual provider · NPI-1

Dr. Reynaldo Puertollano Baduya Sr., D.M.D

Dentist, General Practice · Providence, RI

NPI number1356409247

StatusActive

Last updated in NPPESJul 8, 2007

Details

NPI: 1356409247
Entity type: Individual (NPI-1)
Name: Dr. Reynaldo Puertollano Baduya Sr.
Credential: D.M.D
Sex: Male
Sole proprietor: Yes
Enumeration date: Dec 5, 2006
Last updated: Jul 8, 2007

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223G0001X	Dentist, General Practice	DEN02491	RI	Yes

Practice location

252 Adelaide Ave
Providence, RI 02907-1833

Phone 401-941-2600 · Fax 401-941-2695

Mailing address

252 Adelaide Ave
Providence, RI 02907-1833

Phone 401-941-2600 · Fax 401-941-2695

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