Provider Demographics
NPI:1063119071
Name:OCEAN STATE DENTAL HYGIENE SERVICES, LLC
Entity type:Organization
Organization Name:OCEAN STATE DENTAL HYGIENE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERIQUITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-374-4151
Mailing Address - Street 1:1522 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3819
Mailing Address - Country:US
Mailing Address - Phone:401-827-9939
Mailing Address - Fax:
Practice Address - Street 1:1522 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3819
Practice Address - Country:US
Practice Address - Phone:401-827-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty