Healthcare Provider Details

I. General information

NPI: 1336142165
Provider Name (Legal Business Name): ARROWHEAD DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 S COUNTY TRL
CHARLESTOWN RI
02813-3182
US

IV. Provider business mailing address

4995 S COUNTY TRL
CHARLESTOWN RI
02813-3182
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-6300
  • Fax: 401-364-9190
Mailing address:
  • Phone: 401-364-6300
  • Fax: 401-364-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1824
License Number StateRI

VIII. Authorized Official

Name: DR. BRUCE D GOUIN
Title or Position: OWNER
Credential: D.M.D.
Phone: 401-364-6300