Provider Demographics
NPI:1215292719
Name:ARTISTIC CONTOURS LLC
Entity type:Organization
Organization Name:ARTISTIC CONTOURS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MO
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:401-739-5500
Mailing Address - Street 1:243 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3818
Mailing Address - Country:US
Mailing Address - Phone:401-739-5500
Mailing Address - Fax:
Practice Address - Street 1:243 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3818
Practice Address - Country:US
Practice Address - Phone:401-739-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI13998261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical