NPI 1114745155 · live from the CMS NPI Registry
Boustani Periodontics PC
Dentist, Periodontics in Providence, RI. National Provider Identifier 1114745155, active.
NPI record
| NPI | 1114745155 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Periodontics 1223P0300X |
| Practice location | 40 Elmgrove Ave, Providence, RI 02906 |
| Practice phone | 401-421-1717 |
| Enumerated | September 30, 2024 |
| Last updated | September 30, 2024 |
| Authorized official | Gabriel Boustani, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Periodontics primary | 1223P0300X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.