Provider Demographics
NPI:1104998467
Name:MARK P. SMALL, DMD, INC.
Entity type:Organization
Organization Name:MARK P. SMALL, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-738-2500
Mailing Address - Street 1:1090 NEW LONDON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3035
Mailing Address - Country:US
Mailing Address - Phone:401-738-2500
Mailing Address - Fax:401-463-6898
Practice Address - Street 1:1090 NEW LONDON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3035
Practice Address - Country:US
Practice Address - Phone:401-738-2500
Practice Address - Fax:401-463-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI24421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty