Healthcare Provider Details

I. General information

NPI: 1306859749
Provider Name (Legal Business Name): DR. BRAD JOHN TURCHETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 POST RD SUITE 204
WARWICK RI
02886-1547
US

IV. Provider business mailing address

1865 POST RD SUITE 204
WARWICK RI
02886-1547
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-5252
  • Fax: 401-739-2064
Mailing address:
  • Phone: 401-739-5252
  • Fax: 401-739-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2642
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: