Provider Demographics
NPI:1063498525
Name:ITALIANE-DECUBELLIS, JAMIE MICHELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MICHELE
Last Name:ITALIANE-DECUBELLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5911
Mailing Address - Country:US
Mailing Address - Phone:401-828-7070
Mailing Address - Fax:401-828-7125
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5911
Practice Address - Country:US
Practice Address - Phone:401-828-7070
Practice Address - Fax:401-828-7125
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI028071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI202020448OtherFEDERAL ID
RI202020448OtherFEDERAL ID