31 Elmgrove Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

31 ELMGROVE DENTAL LLC

Practice address

31 Elmgrove Ave
Providence, RI 02906-4103

Phone

(401) 421-9350

Fax

(401) 421-6450

NPI assigned

Mar 22, 2022

Last updated

Mar 22, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jessica A Polak, CDA

Title

Office Manager

Phone

(401) 421-9350

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• dr lawrence d page dmd inc Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lawrence D Page, DMD

  • Dentist
  • Prov, RI
  • NPI 1134260532
  NPD (past)
• Marc Jeffrey Page, DMD

  • Dentist
  • Providence, RI
  • NPI 1366462236
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1225787708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ELMGROVE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ELMGROVE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064103",
            "telephone_number": "401-421-9350",
            "fax_number": "401-421-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "31 ELMGROVE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "POLAK",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "401-421-9350",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CDA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MP01974",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dr lawrence d page dmd inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• A Fitting Experience

• General Practice Dentistry in Providence, RI
• Providers in Providence, RI by specialty
• General Practice Dentistry in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.