Provider Demographics
NPI:1215592720
Name:FRENCHTOWN DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:FRENCHTOWN DENTAL ASSOCIATES LLC
Other - Org Name:WICKFORD VILLAGE DENTAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-599-2505
Mailing Address - Street 1:2580 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1721
Mailing Address - Country:US
Mailing Address - Phone:401-884-7300
Mailing Address - Fax:
Practice Address - Street 1:181 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5115
Practice Address - Country:US
Practice Address - Phone:401-294-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty