MEDICARE: DR. BRAD JOHN TURCHETTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2642	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1863667	OTHER	RI	UNITED CONCORDIA PROVIDER
2	8434-5	OTHER	RI	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1306859749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD JOHN TURCHETTA

Provider Business Mailing Address
First Line	:	1865 POST RD
Second Line	:	SUITE 204
City	:	WARWICK
State	:	RI
Zip	:	02886-1547
Country	:	US
Telephone Number	:	401-739-5252
Fax Number	:	401-739-2064

Provider Business Practice Location Address
First Line	:	1865 POST RD
Second Line	:	SUITE 204
City	:	WARWICK
State	:	RI
Zip	:	02886-1547
Country	:	US
Telephone Number	:	401-739-5252
Fax Number	:	401-739-2064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BRAD JOHN TURCHETTA ” Practice Location

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