Provider Demographics
NPI:1073836896
Name:CHAPEL VIEW FAMILY & COSMETIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:CHAPEL VIEW FAMILY & COSMETIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LORD
Authorized Official - Last Name:DEL GIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-944-8103
Mailing Address - Street 1:30 CHAPEL VIEW BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3062
Mailing Address - Country:US
Mailing Address - Phone:401-944-8103
Mailing Address - Fax:401-944-1854
Practice Address - Street 1:30 CHAPEL VIEW BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3062
Practice Address - Country:US
Practice Address - Phone:401-944-8103
Practice Address - Fax:401-944-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8333-9OtherBLUE CROSS DENTAL