Provider Demographics
NPI:1518562750
Name:YOUR PROFILE DENTAL, LLC
Entity Type:Organization
Organization Name:YOUR PROFILE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-228-3999
Mailing Address - Street 1:888 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3742
Mailing Address - Country:US
Mailing Address - Phone:401-228-3999
Mailing Address - Fax:401-228-3966
Practice Address - Street 1:888 BROADWAY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3742
Practice Address - Country:US
Practice Address - Phone:401-228-3999
Practice Address - Fax:401-228-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty