Provider Demographics
NPI:1659350312
Name:MANSOLILLO MANSOLILLO & MANSOLILLO DDS
Entity Type:Organization
Organization Name:MANSOLILLO MANSOLILLO & MANSOLILLO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MANSOLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-861-1080
Mailing Address - Street 1:1347 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-861-1080
Mailing Address - Fax:401-861-5706
Practice Address - Street 1:1347 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-861-1080
Practice Address - Fax:401-861-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty