Provider Demographics
NPI:1902424674
Name:EAST PROVIDENCE DENTAL CARE, LLC
Entity Type:Organization
Organization Name:EAST PROVIDENCE DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUNAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-367-3369
Mailing Address - Street 1:2441 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2915
Mailing Address - Country:US
Mailing Address - Phone:401-438-4985
Mailing Address - Fax:
Practice Address - Street 1:2441 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2915
Practice Address - Country:US
Practice Address - Phone:401-438-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty