Provider Demographics
NPI:1760029425
Name:BRANCH VILLAGE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:BRANCH VILLAGE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KIRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:401-309-6259
Mailing Address - Street 1:501 GREAT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6833
Mailing Address - Country:US
Mailing Address - Phone:401-309-6259
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-369-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental