Healthcare Provider Details

I. General information

NPI: 1962426866
Provider Name (Legal Business Name): ROBERT STEVEN SEMCO DMD, MS, D.ABDSM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/15/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E MAIN RD
MIDDLETOWN RI
02842-4912
US

IV. Provider business mailing address

58 E MAIN RD
MIDDLETOWN RI
02842-4912
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-5252
  • Fax:
Mailing address:
  • Phone: 401-848-5252
  • Fax: 401-848-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN02595
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: