Provider Demographics
NPI:1912297425
Name:REYNALDO P BADUYA SR.,DMD
Entity type:Organization
Organization Name:REYNALDO P BADUYA SR.,DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:401-941-2600
Mailing Address - Street 1:252 ADELAIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907
Mailing Address - Country:US
Mailing Address - Phone:401-941-2600
Mailing Address - Fax:401-941-2695
Practice Address - Street 1:252 ADELAIDE AVENUE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907
Practice Address - Country:US
Practice Address - Phone:401-941-2600
Practice Address - Fax:401-941-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2491261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRB33847Medicaid