Provider Demographics
NPI:1790952174
Name:EAST BAY DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EAST BAY DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-245-8444
Mailing Address - Street 1:1052 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-4375
Mailing Address - Country:US
Mailing Address - Phone:401-245-8444
Mailing Address - Fax:401-245-9170
Practice Address - Street 1:1052 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-4375
Practice Address - Country:US
Practice Address - Phone:401-245-8444
Practice Address - Fax:401-245-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty