Provider Demographics
NPI:1265759567
Name:CITY DENTAL OF WOONSOCKET, LLC
Entity type:Organization
Organization Name:CITY DENTAL OF WOONSOCKET, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:401-597-5920
Mailing Address - Street 1:515 SOCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2043
Mailing Address - Country:US
Mailing Address - Phone:401-597-5920
Mailing Address - Fax:
Practice Address - Street 1:515 SOCIAL ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-2043
Practice Address - Country:US
Practice Address - Phone:401-597-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1548321235OtherNP INDIVIDUAL