Healthcare Provider Details

I. General information

NPI: 1689726762
Provider Name (Legal Business Name): GEORGE JOSEPH DUPONT III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET JOSEPH SAMUELS DENTAL CENTER AT RIH
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY STREET JOSEPH SAMUELS DENTAL CENTER AT RIH
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8302
  • Fax: 401-444-3494
Mailing address:
  • Phone: 401-444-8302
  • Fax: 401-444-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN02524
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: