Active NPI
Farisa Surattanont Mulvey, D.D.S.
- Pediatric Dentistry
- Providence, RI
National Provider Identifier
1275583874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2834
- Practice address
- 148 Waterman St
Providence, RI 02906-2130 - Phone
- (401) 272-3443
- Fax
- (401) 272-3539
- NPI assigned
- May 12, 2006
- Last updated
- Jul 13, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2834 | RI | Primary |
Addresses
Primary practice location
148 Waterman St
Providence, RI 02906-2130
Mailing address
148 Waterman St
P.O. Box 2608
Providence, RI 02906-2130
Phone (401) 272-3443
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FS53913 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2834 | RI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1275583874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "148 WATERMAN ST",
"address_2": "P.O. BOX 2608",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029062130",
"telephone_number": "401-272-3443",
"fax_number": "401-272-3539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 WATERMAN ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029062130",
"telephone_number": "401-272-3443",
"fax_number": "401-272-3539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULVEY",
"first_name": "FARISA",
"middle_name": "SURATTANONT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "RI",
"license": "2834",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FS53913",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.