Provider Demographics
NPI:1184294704
Name:DR CHRISTA'S GROOVY MOLARS PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:DR CHRISTA'S GROOVY MOLARS PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-499-5815
Mailing Address - Street 1:9 KAREN ANN DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2312
Mailing Address - Country:US
Mailing Address - Phone:401-499-5815
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT TONER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02763-1143
Practice Address - Country:US
Practice Address - Phone:401-499-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty