Provider Demographics
NPI:1225153976
Name:DEIGNAN, EDWARD JOSEPH JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:DEIGNAN
Suffix:JR
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 1:22 WHIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4732
Mailing Address - Country:US
Mailing Address - Phone:401-734-4402
Mailing Address - Fax:
Practice Address - Street 1:935 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4437
Practice Address - Country:US
Practice Address - Phone:401-943-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI15101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice