Healthcare Provider Details

I. General information

NPI: 1427170208
Provider Name (Legal Business Name): OMS SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1524 ATWOOD AVE SUITE #137
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

1524 ATWOOD AVE SUITE #137
JOHNSTON RI
02919-3228
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-8029
  • Fax: 401-751-0266
Mailing address:
  • Phone: 401-751-8029
  • Fax: 401-751-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDNT1823
License Number StateRI

VIII. Authorized Official

Name: DR. RICHARD E. GORDON
Title or Position: OWNER
Credential: DMD
Phone: 401-751-8029