Provider Demographics
NPI:1326754094
Name:MARIGOLD DENTAL STUDIO LLC
Entity Type:Organization
Organization Name:MARIGOLD DENTAL STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-600-1713
Mailing Address - Street 1:80 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4212
Mailing Address - Country:US
Mailing Address - Phone:401-497-8104
Mailing Address - Fax:
Practice Address - Street 1:727 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6185
Practice Address - Country:US
Practice Address - Phone:401-266-3613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental