| Organization Name: | ANGELL STREET DENTAL ASSOCIATES, INC |
| NPI Number: | 1013173277 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES MICHAEL RIOTTO (PRESIDENT) |
| Mailing Address: | 425 Angell St Providence |
| State: | RI US |
| Postal Code: | 029064403 |
| Phone Number: | 4012722331 |
| Fax Number: | 4012722361 |
| NPI Enumeration Date: | 08/06/2008 |
| NPI Last Update Date: | 08/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | RI2044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |