MEDICARE: FRANK A. DEQUATTRO, DMD

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	02711	RI

General Provider Information

NPI Number	:	1508828088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK A. DEQUATTRO, DMD

Provider Business Mailing Address
First Line	:	24 SALT POND RD
Second Line	:	SUITE C1
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 SALT POND RD
Second Line	:	SUITE C1
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4314
Country	:	US
Telephone Number	:	401-783-9890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANK ALBERT DEQUATTRO
Credential	:	DMD
Telephone Number	:	401-783-9890

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

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