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General NPI Number Information
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NPI Number | 1124231253
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Entity Type | Individual
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Provider Name | DANIEL PETER DECESARE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 1740 ATWOOD AVE.
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City | JOHNSTON
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State | RI
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Zip | 02919-3269
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Country | US
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Telephone | 401-233-9800
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Fax | 401-233-9898
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Provider Business Mailing Address
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Address Line | 1740 ATWOOD AVE.
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City | JOHNSTON
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State | RI
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Zip | 02919-3269
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Country | US
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Telephone | 401-233-9800
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Fax | 401-233-9898
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DEN01328
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License Number State | RI
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