Provider Demographics
NPI:1063542520
Name:PIERCE, CALVIN J (DMD PHD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PHILLIPS ST
Mailing Address - Street 2:CALVIN J PIERCE DMD PHD
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5179
Mailing Address - Country:US
Mailing Address - Phone:401-294-4315
Mailing Address - Fax:
Practice Address - Street 1:145 PHILLIPS STREET
Practice Address - Street 2:
Practice Address - City:NO KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5179
Practice Address - Country:US
Practice Address - Phone:401-294-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 647103TC0700X
RIDEN026201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICP25709Medicaid
RI87494OtherBCBS OF RI