Provider Demographics
NPI:1598222689
Name:AMERICAN CENTER FOR BIOREGULATORY MEDICINE AND DENTISTRY
Entity Type:Organization
Organization Name:AMERICAN CENTER FOR BIOREGULATORY MEDICINE AND DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTES-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:401-270-1177
Mailing Address - Street 1:111 CHESTNUT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4169
Mailing Address - Country:US
Mailing Address - Phone:833-824-6633
Mailing Address - Fax:
Practice Address - Street 1:111 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4169
Practice Address - Country:US
Practice Address - Phone:833-824-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty