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General NPI Number Information
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NPI Number | 1689779290
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Entity Type | Organization
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Legal Business Name | ROY A RAGGE DMD INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 222 JEFFERSON BLVD
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City | WARWICK
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State | RI
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Zip | 02888
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Country | US
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Telephone | 401-736-5136
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Fax | 401-736-0614
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Provider Business Mailing Address
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Address Line | 222 JEFFERSON BLVD
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City | WARWICK
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State | RI
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Zip | 02888
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Country | US
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Telephone | 401-736-5136
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Fax | 401-736-0614
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROY A RAGGE
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Credential | DMD
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Telephone | 401-736-5136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN2034
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License Number State | RI
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