Provider Demographics
NPI:1033211032
Name:MUTEWERA, PERI (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERI
Middle Name:
Last Name:MUTEWERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAMBERT LIND HWY
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1135
Mailing Address - Country:US
Mailing Address - Phone:401-738-2193
Mailing Address - Fax:401-732-5367
Practice Address - Street 1:50 LAMBERT LIND HWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1135
Practice Address - Country:US
Practice Address - Phone:401-738-2193
Practice Address - Fax:401-732-5367
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN027861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice