MEDICARE: DR. JOHN O. EASTMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1491	RI

General Provider Information

NPI Number	:	1396751178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN O. EASTMAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 4869
Second Line	:
City	:	RUMFORD
State	:	RI
Zip	:	02916-0869
Country	:	US
Telephone Number	:	401-438-5577
Fax Number	:	401-438-5577

Provider Business Practice Location Address
First Line	:	225 NEWMAN AVE
Second Line	:
City	:	RUMFORD
State	:	RI
Zip	:	02916-1218
Country	:	US
Telephone Number	:	401-438-5577
Fax Number	:	401-438-5577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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