Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DEN03280 | RI |
NPI | 1053759225 |
---|---|
Provider Name | Robyn M Hofelich |
First Address | Coventry, RI 02816-5914 |
Second Address | Coventry, RI 02816-5914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 28/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DEN03280 | RI DENTAL LICENSE (01) | RI |