1780121350 NPI number — JOANNE C LEWIS PEDIATRIC DENTISTRY LLC

Table of content: (NPI 1780121350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780121350 NPI number — JOANNE C LEWIS PEDIATRIC DENTISTRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOANNE C LEWIS PEDIATRIC DENTISTRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S DENTISTRY OF EAST GREENWICH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780121350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 POST RD UNIT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST GREENWICH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02818-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-285-2500
Provider Business Mailing Address Fax Number:
401-823-1702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 POST RD UNIT 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-285-2500
Provider Business Practice Location Address Fax Number:
401-823-1702
Provider Enumeration Date:
01/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
401-285-2500

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1497729370 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 1114362506 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 1487644852 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 1053759225 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912036013 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487644852 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1891157145 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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