Provider Demographics
NPI:1689898678
Name:DENTAL SERVICES , P.C.
Entity Type:Organization
Organization Name:DENTAL SERVICES , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYLAND
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-749-2345
Mailing Address - Street 1:69 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3008
Mailing Address - Country:US
Mailing Address - Phone:401-749-2345
Mailing Address - Fax:401-274-7375
Practice Address - Street 1:40 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4444
Practice Address - Country:US
Practice Address - Phone:401-737-9363
Practice Address - Fax:401-737-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI207L00000X207L00000X
RIDEN02883261QD0000X
RI122300000X
MA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWE57613Medicaid