Provider Demographics
NPI:1184740706
Name:DA ROSA, PAULO JORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULO
Middle Name:JORGE
Last Name:DA ROSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MILL ST.
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-722-2699
Mailing Address - Fax:401-722-2610
Practice Address - Street 1:20 MILL ST.
Practice Address - Street 2:SUITE #3
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-722-2699
Practice Address - Fax:401-722-2610
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN027211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice