| Periodontics Incorporated | |
|
167 Gano Street Providence RI 02906 | |
| (401) 274-2600 | |
| (401) 421-7875 |
| Full Name | Periodontics Incorporated |
|---|---|
| Speciality | Dentist |
| Location | 167 Gano Street, Providence, Rhode Island |
| Authorized Official Name and Position | Scott M Fertik (PRESIDENT) |
| Authorized Official Contact | 4012742600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontics Incorporated 167 Gano Street Providence RI 02906 Ph: (401) 274-2600 | Periodontics Incorporated 167 Gano Street Providence RI 02906 Ph: (401) 274-2600 |
| NPI Number | 1841398658 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841398658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DEN02345 (Rhode Island) | Primary |
| 122300000X | Dentist | DEN02700 (Rhode Island) | Secondary |
| 122300000X | Dentist | DEN01328 (Rhode Island) | Secondary |
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