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General NPI Number Information
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NPI Number | 1780858639
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Entity Type | Organization
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Legal Business Name | JEFFERSON DENTAL ASSOCIATES, L.T.D.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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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 | 02888-3855
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Country | US
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Telephone | 401-739-2350
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Fax |
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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 | 02888-3855
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Country | US
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Telephone | 401-739-2350
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELVIN ERIC HANZEL
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Credential | D.M.D.
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Telephone | 401-739-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2610
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License Number State | RI
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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 | 2654
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 1681
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License Number State | RI
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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 | 1846
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License Number State | RI
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