Provider Demographics
NPI:1629353552
Name:ASCIOLLA FAMILY DENTISTRY INC
Entity Type:Organization
Organization Name:ASCIOLLA FAMILY DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-884-5242
Mailing Address - Street 1:880 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3113
Mailing Address - Country:US
Mailing Address - Phone:401-884-5242
Mailing Address - Fax:401-884-9464
Practice Address - Street 1:880 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3113
Practice Address - Country:US
Practice Address - Phone:401-884-5242
Practice Address - Fax:401-884-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI024601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty