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General NPI Number Information
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NPI Number | 1336548130
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 6 LAMBERT STREET
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City | NARRAGANSETT
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State | RI
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Zip | 02882-3399
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Country | US
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Telephone | 401-789-7200
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Fax | 401-789-7205
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Provider Business Mailing Address
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Address Line | 6 LAMBERT STREET
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City | NARRAGANSETT
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State | RI
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Zip | 02882-3399
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Country | US
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Telephone | 401-789-7200
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Fax | 401-789-7205
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. MATTHEW WESTCOTT DOWNEY
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Credential | DMD
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Telephone | 401-789-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN03116
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License Number State | RI
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