Provider Demographics
NPI:1013756683
Name:401 DENTAL, LLC
Entity type:Organization
Organization Name:401 DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-660-7460
Mailing Address - Street 1:53 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3568
Mailing Address - Country:US
Mailing Address - Phone:401-660-7460
Mailing Address - Fax:
Practice Address - Street 1:41 SANDERSON RD STE 106
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2611
Practice Address - Country:US
Practice Address - Phone:401-349-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental