Healthcare Provider Details

I. General information

NPI: 1750723276
Provider Name (Legal Business Name): NEWPORT PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD BEACH RD
NEWPORT RI
02840-3285
US

IV. Provider business mailing address

15 OLD BEACH RD
NEWPORT RI
02840-3285
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-4790
  • Fax:
Mailing address:
  • Phone: 401-849-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FAITH C DRENNON
Title or Position: DENTIST
Credential: DMD
Phone: 401-849-4790