Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Boustani Periodontics PC

Organization Periodontics · NPI 1114745155

Boustani Periodontics PC is a Periodontics in Providence, Rhode Island. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

40 Elmgrove Ave
Providence, RI 02906-4104
Phone: (401) 421-1717
Fax: (401) 421-0066
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X

Record details

NPI number1114745155
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gabriel Boustani — President · (617) 640-4637
NPI enumeratedSeptember 30, 2024
Last updated in NPPESSeptember 30, 2024
Certification dateSeptember 30, 2024
Mailing address40 Elmgrove Ave, Providence, RI 02906-4104

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