Provider Demographics
NPI:1427128701
Name:MACGILLIVRAY, PETER A (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MACGILLIVRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-3814
Mailing Address - Country:US
Mailing Address - Phone:401-353-0800
Mailing Address - Fax:401-354-4240
Practice Address - Street 1:1635 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4025
Practice Address - Country:US
Practice Address - Phone:401-353-0800
Practice Address - Fax:401-354-4240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI DEN 021401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2140OtherBCBS OF RI