Healthcare Provider Details

I. General information

NPI: 1871679415
Provider Name (Legal Business Name): SAMUEL R. ZWETCHKENBAUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WOODBURY ST
PROVIDENCE RI
02906-3510
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-588-1295
  • Fax:
Mailing address:
  • Phone: 401-780-2511
  • Fax: 401-780-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016737
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01757400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN02285
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI01757400
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901016737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: