Provider Demographics
NPI:1134567308
Name:FAIELLA, ASHLEY (DMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FAIELLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4936
Mailing Address - Country:US
Mailing Address - Phone:401-846-6610
Mailing Address - Fax:401-846-0804
Practice Address - Street 1:97 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4936
Practice Address - Country:US
Practice Address - Phone:401-846-6610
Practice Address - Fax:401-846-0804
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03220122300000X
MADN1856636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDEN03220OtherSTATE OF RI
MADN1856636OtherSTATE OF MA