| Name: | Access Dental Care, P.C., Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 20 Aug 1997 (27 years ago) |
| Identification Number: | 000096490 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 1234 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904, USA |
| Purpose: | TO PROVIDE DENTAL CARE. |
| NAICS: | 621210 - Offices of Dentists |
| Historical names: |
Geriatric Dental Care, P.C., Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992858054 | 2007-01-19 | 2020-08-22 | 1234 MINERAL SPRING AVE, NORTH PROVIDENCE, RI, 029044105, US | 1234 MINERAL SPRING AVE, NORTH PROVIDENCE, RI, 029044105, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 401-722-5800 |
| Fax | 4017226718 |
Authorized person
| Name | MELANIE GENTRY |
| Role | OFFICE MANAGER |
| Phone | 4017225800 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS MA |
| Number | RG0044 |
| State | MA |
| Issuer | MEDICAID |
| Number | AD24688 |
| State | RI |
| Issuer | BLUE CROSS RI |
| Number | 8767-2 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MARYANNE PEZZULLO, ESQ. | Agent | PETRARCA AND MCGAIR INC. 797 BALD HILL ROAD, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| JOHN MANOUSOS | PRESIDENT | 1234 MINERAL SPRING AVENUE NORTH PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| TARANEH TABATABAIE | VICE PRESIDENT | 1234 MINERAL SPRING AVE NORTH PROVIDENCE, RI 02904 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1997-12-04 | Geriatric Dental Care, P.C., Inc. | Access Dental Care, P.C., Inc. |
| Number | Name | File Date |
|---|---|---|
| 202447336140 | Annual Report | 2024-02-27 |
| 202330161860 | Annual Report | 2023-03-08 |
| 202213876560 | Annual Report | 2022-04-04 |
| 202191841080 | Annual Report | 2021-02-17 |
| 202062049700 | Annual Report | 2020-10-06 |
| 202054997020 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201916229350 | Annual Report | 2019-08-29 |
| 201907009710 | Revocation Notice For Failure to File An Annual Report | 2019-07-24 |
| 201859069790 | Annual Report | 2018-02-23 |
| 201737544340 | Annual Report | 2017-03-07 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
