Provider Demographics
NPI:1104238559
Name:ANTHONY MICHAEL PAOLUCCI
Entity type:Organization
Organization Name:ANTHONY MICHAEL PAOLUCCI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PAOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-353-1550
Mailing Address - Street 1:1545 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2943
Mailing Address - Country:US
Mailing Address - Phone:401-353-1550
Mailing Address - Fax:
Practice Address - Street 1:1545 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2943
Practice Address - Country:US
Practice Address - Phone:401-353-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty