Healthcare Provider Details

I. General information

NPI: 1558431767
Provider Name (Legal Business Name): UPDIKE DENTAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPDIKE AVE
N KINGSTOWN RI
02852-5728
US

IV. Provider business mailing address

29 UPDIKE AVE
WICKFORD RI
02852
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-1992
  • Fax:
Mailing address:
  • Phone: 401-295-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateRI

VIII. Authorized Official

Name: CONSTANCE M COUSINS
Title or Position: PRESIDENT
Credential: DDS
Phone: 401-295-1992