Provider Demographics
NPI:1184107880
Name:MICHAEL M. GOODING DMD L.T.D
Entity type:Organization
Organization Name:MICHAEL M. GOODING DMD L.T.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JUBINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-463-7678
Mailing Address - Street 1:1422 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-5026
Mailing Address - Country:US
Mailing Address - Phone:401-463-7678
Mailing Address - Fax:401-463-3897
Practice Address - Street 1:1422 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-5026
Practice Address - Country:US
Practice Address - Phone:401-463-7678
Practice Address - Fax:401-463-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1407997687OtherPERSONAL NPI
RI1700362639OtherPERSONAL NPI MIA GOODING