Provider Demographics
NPI:1699795559
Name:DURUDOGAN, PETER HAKAN (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:HAKAN
Last Name:DURUDOGAN
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 1:16 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5810
Mailing Address - Country:US
Mailing Address - Phone:401-849-0438
Mailing Address - Fax:
Practice Address - Street 1:97 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4936
Practice Address - Country:US
Practice Address - Phone:401-846-6610
Practice Address - Fax:401-846-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0022901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPD00857Medicaid
RIPD00857Medicaid