Healthcare Provider Details

I. General information

NPI: 1508828088
Provider Name (Legal Business Name): FRANK A. DEQUATTRO, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD SUITE C1
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

24 SALT POND RD SUITE C1
WAKEFIELD RI
02879-4314
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-9890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number02711
License Number StateRI

VIII. Authorized Official

Name: DR. FRANK ALBERT DEQUATTRO
Title or Position: OWNER
Credential: DMD
Phone: 401-783-9890