Healthcare Provider Details

I. General information

NPI: 1275618555
Provider Name (Legal Business Name): BRAD R KAPLAN D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 GOVERNOR ST
PROVIDENCE RI
02906-3062
US

IV. Provider business mailing address

149 GOVERNOR ST
PROVIDENCE RI
02906-3062
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-5100
  • Fax: 401-861-1035
Mailing address:
  • Phone: 401-861-5100
  • Fax: 401-861-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2199
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: