Provider Demographics
NPI:1023394947
Name:LIVEWELL DENTAL LLC
Entity Type:Organization
Organization Name:LIVEWELL DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-769-0798
Mailing Address - Street 1:501 GREAT ROAD SUITE #206
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:401-769-0798
Mailing Address - Fax:401-762-0302
Practice Address - Street 1:501 GREAT RD STE 206
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-769-0798
Practice Address - Fax:401-762-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN031371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty