Healthcare Provider Details

I. General information

NPI: 1497130256
Provider Name (Legal Business Name): POOYAN SADR ESHKEVARI MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 S COUNTY TRL LOWR LEVEL
EAST GREENWICH RI
02818-1625
US

IV. Provider business mailing address

1370 S COUNTY TRL LOWR LEVEL
EAST GREENWICH RI
02818-1625
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-1450
  • Fax:
Mailing address:
  • Phone: 401-885-1450
  • Fax: 401-885-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDEN03652
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN03652
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: