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General NPI Number Information
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NPI Number | 1023623576
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Entity Type | Individual
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Provider Name | CHRISTOPHER JAMESON WIDDIFIELD DMD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 24 SALT POND RD STE D1
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City | SOUTH KINGSTOWN
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State | RI
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Zip | 02879-4334
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Country | US
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Telephone | 401-783-1530
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BUCKS TRL
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City | WESTERLY
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State | RI
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Zip | 02891-4085
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Country | US
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Telephone | 401-569-1409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | ETL02636
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License Number State | RI
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