Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 02543 | RI |
N | 1223P0106X | Oral and Maxillofacial Pathology | 02543 | RI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 02543 | RI |
NPI | 1124158589 |
---|---|
Provider Name | Mr. Matthew R Asaro |
First Address | Barrington, RI 02806 |
Second Address | Barrington, RI 02806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02543 | DELTA (01) | |
87403 | BC (01) |