Provider Demographics
NPI:1588731947
Name:HART, EDWARD ALOYSIUS (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALOYSIUS
Last Name:HART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WICKFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-294-3788
Mailing Address - Fax:401-294-3723
Practice Address - Street 1:181 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WICKFORD
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-294-3788
Practice Address - Fax:401-294-3723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist