Provider Demographics
NPI:1487932836
Name:DMR FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:DMR FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADULESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-599-5019
Mailing Address - Street 1:31 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2901
Mailing Address - Country:US
Mailing Address - Phone:401-596-7734
Mailing Address - Fax:401-596-7780
Practice Address - Street 1:31 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2901
Practice Address - Country:US
Practice Address - Phone:401-596-7734
Practice Address - Fax:401-596-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03120302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization