Provider Demographics
NPI:1427242973
Name:MAPLE AVENUE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:MAPLE AVENUE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-247-2200
Mailing Address - Street 1:310 MAPLE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3430
Mailing Address - Country:US
Mailing Address - Phone:401-247-2200
Mailing Address - Fax:401-247-2295
Practice Address - Street 1:310 MAPLE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3430
Practice Address - Country:US
Practice Address - Phone:401-247-2200
Practice Address - Fax:401-247-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN023801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty