Healthcare Provider Details

I. General information

NPI: 1962501908
Provider Name (Legal Business Name): DANIEL JOSEPH KANE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST DEPARTMENT OF PEDIATRIC DENTISTRY
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

451 PLEASANT VALLEY PKWY
PROVIDENCE RI
02908-3503
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-4463
  • Fax: 401-456-4462
Mailing address:
  • Phone: 401-351-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN 02611
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: