Healthcare Provider Details

I. General information

NPI: 1306066071
Provider Name (Legal Business Name): EAST GREENWICH ORAL SURGERY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5586 POST RD SUITE 101
EAST GREENWICH RI
02818-3454
US

IV. Provider business mailing address

5586 POST RD SUITE 101
EAST GREENWICH RI
02818-3454
US

V. Phone/Fax

Practice location:
  • Phone: 401-884-8118
  • Fax: 401-886-5510
Mailing address:
  • Phone: 401-884-8118
  • Fax: 401-886-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN01781
License Number StateRI

VIII. Authorized Official

Name: DR. JOHN E. DUHAIME
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 401-884-8118