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General NPI Number Information
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NPI Number | 1154521201
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Entity Type | Individual
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Provider Name | RUPESH R UDESHI
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 1414 ATWOOD AVE SUITE #350
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City | JOHNSTON
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State | RI
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Zip | 02919-4839
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Country | US
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Telephone | 401-331-7665
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 ATWOOD AVE SUITE #350
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City | JOHNSTON
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State | RI
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Zip | 02919-4839
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Country | US
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Telephone | 401-331-7665
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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 | 053566
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN03011
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22217
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009884
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License Number State | CT
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