Provider Demographics
NPI:1134985245
Name:WELLROOTED DENTISTRY LLC
Entity type:Organization
Organization Name:WELLROOTED DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHAMAMSY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-543-8094
Mailing Address - Street 1:111 CHESTNUT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4169
Mailing Address - Country:US
Mailing Address - Phone:401-533-9632
Mailing Address - Fax:401-415-8608
Practice Address - Street 1:111 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4169
Practice Address - Country:US
Practice Address - Phone:401-533-9632
Practice Address - Fax:401-415-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental