Provider Demographics
NPI:1124679030
Name:WARWICK FAMILY DENTAL GROUP 3, LLC
Entity type:Organization
Organization Name:WARWICK FAMILY DENTAL GROUP 3, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUNAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-367-3369
Mailing Address - Street 1:819 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1815
Mailing Address - Country:US
Mailing Address - Phone:401-739-8337
Mailing Address - Fax:
Practice Address - Street 1:819 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1815
Practice Address - Country:US
Practice Address - Phone:401-739-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty