Provider Demographics
NPI:1306066071
Name:EAST GREENWICH ORAL SURGERY, LTD
Entity type:Organization
Organization Name:EAST GREENWICH ORAL SURGERY, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUHAIME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-884-8118
Mailing Address - Street 1:5586 POST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3454
Mailing Address - Country:US
Mailing Address - Phone:401-884-8118
Mailing Address - Fax:401-886-5510
Practice Address - Street 1:5586 POST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3454
Practice Address - Country:US
Practice Address - Phone:401-884-8118
Practice Address - Fax:401-886-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN017811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT79286Medicare UPIN