Healthcare Provider Details

I. General information

NPI: 1932768876
Provider Name (Legal Business Name): JACQUELYN HADI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYNN MCWILLIAMS

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 S COUNTY TRL
EAST GREENWICH RI
02818-1721
US

IV. Provider business mailing address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

V. Phone/Fax

Practice location:
  • Phone: 401-884-7300
  • Fax:
Mailing address:
  • Phone: 401-519-1940
  • Fax: 401-351-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberLP00177
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1858908
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN03509
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: