Provider Demographics
NPI:1124231253
Name:DECESARE, DANIEL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PETER
Last Name:DECESARE
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 1:1740 ATWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3269
Mailing Address - Country:US
Mailing Address - Phone:401-233-9800
Mailing Address - Fax:401-233-9898
Practice Address - Street 1:1740 ATWOOD AVE.
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3269
Practice Address - Country:US
Practice Address - Phone:401-233-9800
Practice Address - Fax:401-233-9898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN013281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics