The Family Dentist

NPI #1013164920 in Pawtucket, Rhode Island

Provider Information

NPI Number: 1013164920
Entity Type: Organization
Organization Name: The Family Dentist
Primary Specialty: Dentist
Enumeration Date: Aug 21, 2008
Last Updated: Aug 21, 2008

Practice Location

Address: 480 BROADWAY
City: Pawtucket
State: Rhode Island
ZIP Code: 02860-1340
Phone: (401) 728-6654

Authorized Official

Name: DR. MICHAEL A. WAGNER, DDS
Title: PRESIDENT
Phone: (401) 728-6654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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